MEDICARE: MS. MARSHA LYNNE KIRCHNER L.C.P.C.

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	101YP2500X	Professional Counselor	378	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001037783	OTHER	MT	MHN SERVICES PROVIDER NO.
2	134838	OTHER	MT	COMPSYCH CORP. PROVIDER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0005456426	OTHER	MT	AETNA PROVIDER NUMBER
5	74473	OTHER	MT	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1639190507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARSHA LYNNE KIRCHNER L.C.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 335
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59806-0335
Country	:	US
Telephone Number	:	406-728-8458
Fax Number	:	406-721-5234

Provider Business Practice Location Address
First Line	:	800 KENSINGTON AVE
Second Line	:	SUITE LL3
City	:	MISSOULA
State	:	MT
Zip	:	59801-5674
Country	:	US
Telephone Number	:	406-728-8458
Fax Number	:	406-721-5234

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/09/2007

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