=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619499803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA J RICHESON LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2017
-----------------------------------------------------
Last Update Date | 01/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 24TH ST W STE 255
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-3894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-769-1820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5201 FRONTIER DR
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-8918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-769-1820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | BBH-LCPC-LIC-25186
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------