MEDICARE: MS. CORIN JACKLYN FISCH

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-1223	MT
2	101YP2500X	Professional Counselor	BBH-LCPC-LIC-1569	MT

General Provider Information

NPI Number	:	1598082380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORIN JACKLYN FISCH

Provider Business Mailing Address
First Line	:	PO BOX 6325
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59406-6325
Country	:	US
Telephone Number	:	406-868-5370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 2ND AVE N STE 336
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3243
Country	:	US
Telephone Number	:	406-868-5370
Fax Number	:

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	10/01/2025

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