=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083421127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY KARYN MCFADDEN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2024
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 431 1ST AVE W
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-4959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-607-4954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 CEDAR ST
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-260-6949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | BBH-LCSW-LIC76016
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------