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MS. LISA RAE ANDERSON MANGAN LCPC

Professional >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1699772079

Individual Registrant:
MS. LISA RAE ANDERSON MANGAN LCPC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
120 23RD AVE NE  GREAT FALLS, MT 59404-1445 US
Tel: 406-453-6784  Fax: 406-453-6793

Contact information for business:
120 23RD AVE NE  GREAT FALLS, MT 59404-1445 US
Tel: 406-453-6784  Fax: 406-453-6793

Registration Information:
NPI: 1699772079
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers
Counselor
Professional
MTLCPC 762

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
0252331MT05
FEDERAL TAX ID NUMBER810519345MT01
BLUE CROSS BLUE SHIELD074938MT01




HEALTH CARE JOBS MT - Page 1

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