MEDICARE: ASHLY HOLLAND FRY LCSW, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-LAC-LIC-63795	MT
2	101YM0800X	Mental Health Counselor	BBH-LCSW-LIC-80829	MT

General Provider Information

NPI Number	:	1114899069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLY HOLLAND FRY LCSW, LAC

Provider Business Mailing Address
First Line	:	PO BOX 273
Second Line	:
City	:	LIVINGSTON
State	:	MT
Zip	:	59047-0273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S MAIN ST STE 500
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1498
Country	:	US
Telephone Number	:	406-223-5213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	09/20/2025

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