Provider Demographics
NPI:1356654057
Name:STREICH, LISA ASHLEY (LCPC, LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ASHLEY
Last Name:STREICH
Suffix:
Gender:F
Credentials:LCPC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 KODIAK PL
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9042
Mailing Address - Country:US
Mailing Address - Phone:406-599-3818
Mailing Address - Fax:
Practice Address - Street 1:601 NIKLES DR STE 6
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2570
Practice Address - Country:US
Practice Address - Phone:406-599-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101Y00000X
MT570343-09225700000X
MTBBH-LCPC-LIC-43684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist