=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396089785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MICHELLE FRAZER LCPC, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2012
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 DEWEY BLVD STE B
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-782-4778
-----------------------------------------------------
Fax | 406-782-1318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 4TH ST
-----------------------------------------------------
City | DEER LODGE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59722-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-560-3995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 2592
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 31906
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------