MEDICARE: KRISTIN KIMBERLY STRATFORD LCPC

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	BBH-LCPC-LIC-36862	MT
2	101YP2500X	Professional Counselor	BBH-PCLC-LIC-29945	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BBH-PCLC-LIC-29945	OTHER	MT	NEW STATE LICENSE

General Provider Information

NPI Number	:	1972074888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN KIMBERLY STRATFORD LCPC

Provider Business Mailing Address
First Line	:	1100 W KENT AVE # 2741
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-9998
Country	:	US
Telephone Number	:	406-544-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W KENT AVE # 2741
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-9998
Country	:	US
Telephone Number	:	406-544-2833
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	10/23/2024

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