Provider Demographics
NPI:1649756362
Name:AMEN, LYNELLE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:LYNELLE
Middle Name:
Last Name:AMEN
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N 29TH ST STE 231
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1991
Mailing Address - Country:US
Mailing Address - Phone:406-696-5134
Mailing Address - Fax:406-206-4272
Practice Address - Street 1:208 N 29TH ST STE 231
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1991
Practice Address - Country:US
Practice Address - Phone:406-696-5134
Practice Address - Fax:406-206-4272
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-31474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1649756362Medicaid