Provider Demographics
NPI:1639190507
Name:KIRCHNER, MARSHA LYNNE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:LYNNE
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:LCPC
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 335
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-0335
Mailing Address - Country:US
Mailing Address - Phone:406-728-8458
Mailing Address - Fax:406-721-5234
Practice Address - Street 1:800 KENSINGTON AVE
Practice Address - Street 2:SUITE LL3
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5674
Practice Address - Country:US
Practice Address - Phone:406-728-8458
Practice Address - Fax:406-721-5234
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0001037783OtherMHN SERVICES PROVIDER NO.
MT134838OtherCOMPSYCH CORP. PROVIDER
MT0251914Medicaid
MT0005456426OtherAETNA PROVIDER NUMBER
MT74473OtherBLUE CROSS/BLUE SHIELD