MEDICARE: MRS. CRYSTAL MONIQUE KIRSCHMAN MA, LCPC, NCC

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	101YM0800X	Mental Health Counselor	0168341	NM
2	101YM0800X	Mental Health Counselor	12475	MT

General Provider Information

NPI Number	:	1932283835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL MONIQUE KIRSCHMAN MA, LCPC, NCC

Provider Business Mailing Address
First Line	:	802 GUMWOOD ST
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-7924
Country	:	US
Telephone Number	:	575-749-2057
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 CENTRAL AVENUE
Second Line	:	SUITE 407
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3143
Country	:	US
Telephone Number	:	406-952-3772
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/02/2016

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