Provider Demographics
NPI:1497023451
Name:FRIELDS, RYAN J (LAC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:FRIELDS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-0905
Mailing Address - Country:US
Mailing Address - Phone:406-396-5346
Mailing Address - Fax:
Practice Address - Street 1:396 BIG BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:TROUT CREEK
Practice Address - State:MT
Practice Address - Zip Code:59874-9630
Practice Address - Country:US
Practice Address - Phone:406-396-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1419101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)