=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235719980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LYNN DION LAC, NBC-HWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2021
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 WULFF LN
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59922-9643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-885-3849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 991
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59922-0991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-885-3849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | 37552
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | BBH-LAC-LIC-2620
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------