Provider Demographics
NPI:1598082380
Name:FISCH, CORIN JACKLYN
Entity Type:Individual
Prefix:MS
First Name:CORIN
Middle Name:JACKLYN
Last Name:FISCH
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:PO BOX 6325
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6325
Mailing Address - Country:US
Mailing Address - Phone:406-868-5370
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 336
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3243
Practice Address - Country:US
Practice Address - Phone:406-868-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1223101YA0400X
MTBBH-LCPC-LIC-1569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)