=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396804738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA JONES LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 11/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 GRAND AVE
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-5922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-7510
-----------------------------------------------------
Fax | 406-252-7510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 GRAND AVE
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-5922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-7510
-----------------------------------------------------
Fax | 406-252-7510
-----------------------------------------------------
=====================================================
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 | 393
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------