Provider Demographics
NPI:1679630347
Name:FUSON, CHARLOTTE E (LCPC, LAC)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:E
Last Name:FUSON
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5634
Mailing Address - Country:US
Mailing Address - Phone:406-449-3949
Mailing Address - Fax:406-449-8828
Practice Address - Street 1:535 SADDLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5634
Practice Address - Country:US
Practice Address - Phone:406-449-3949
Practice Address - Fax:406-449-8828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT731101YA0400X
MT471LCPC101YP2500X
MTLMFT2230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT253331Medicaid