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General NPI Number Information
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NPI Number | 1447499918
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Entity Type | Individual
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Provider Name | CHERYL A. BASTA LCPC 57404; LAC 1290
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Gender | Female
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 1301 12TH AVE S STE 103
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City | GREAT FALLS
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State | MT
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Zip | 59405-4600
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Country | US
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Telephone | 406-836-2714
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Fax | 888-624-2676
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Provider Business Mailing Address
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Address Line | PO BOX 6025
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City | GREAT FALLS
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State | MT
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Zip | 59406-6025
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Country | US
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Telephone | 406-836-2714
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Fax | 888-624-2676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 57404
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1290
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 57404
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 57404
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License Number State | MT
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