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General NPI Number Information
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NPI Number | 1568808665
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Entity Type | Individual
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Provider Name | TAWNY LYNN STARK LCPC, LAC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 2475 VILLAGE LN STE 102
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City | BILLINGS
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State | MT
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Zip | 59102-2497
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Country | US
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Telephone | 406-855-7255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50538
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City | BILLINGS
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State | MT
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Zip | 59105-0538
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Country | US
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Telephone | 406-855-7255
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LAC-LAC-LIC-1348
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | SWP-LCPC-LIC-2439
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License Number State | MT
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