Provider Demographics
NPI:1023180213
Name:VISSCHER, CHRISTINE S (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:VISSCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HAGGERTY LN STE 14
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1780
Mailing Address - Country:US
Mailing Address - Phone:406-586-3767
Mailing Address - Fax:
Practice Address - Street 1:333 HAGGERTY LN STE 14
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1780
Practice Address - Country:US
Practice Address - Phone:406-586-3767
Practice Address - Fax:406-586-2326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0501789Medicaid