Provider Demographics
NPI:1225410988
Name:GARTNER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 44TH ST W APT 2103
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3917
Mailing Address - Country:US
Mailing Address - Phone:802-380-8091
Mailing Address - Fax:
Practice Address - Street 1:1732 S 72ND ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3538
Practice Address - Country:US
Practice Address - Phone:406-245-2751
Practice Address - Fax:406-256-7026
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-19173101YM0800X
101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1225410988Medicaid