MEDICARE: RONALD GLENN FISCHER 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-LAC-LIC-59866	MT

General Provider Information

NPI Number	:	1992524441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD GLENN FISCHER LAC

Provider Business Mailing Address
First Line	:	609 W GALENA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1507
Country	:	US
Telephone Number	:	406-640-8069
Fax Number	:	406-303-5264

Provider Business Practice Location Address
First Line	:	609 W GALENA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1507
Country	:	US
Telephone Number	:	406-640-8069
Fax Number	:	406-303-5264

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

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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