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NPI Code Detail

MEDICARE: RONALD HENDRICKSON LAC

MEDICARE: RONALD HENDRICKSON 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
1101YA0400XAddiction (Substance Use Disorder) CounselorLAC-LAC-LIC-1421MT

General Provider Information

NPI Number : 1861849366
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD HENDRICKSON LAC
Provider Business Mailing Address
First Line : 109 BELL ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-8607
Country : US
Telephone Number : 406-490-6656
Fax Number : 406-299-3450
Provider Business Practice Location Address
First Line : 630 W MERCURY ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-1510
Country : US
Telephone Number : 406-299-3448
Fax Number : 406-299-3450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 05/16/2016

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Directions to “ RONALD HENDRICKSON LAC” Practice Location

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