Provider Demographics
NPI:1679944771
Name:ZIDACK, ASTRI MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:ASTRI
Middle Name:MARIE
Last Name:ZIDACK
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 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-2500
Mailing Address - Fax:406-657-4945
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-238-2500
Practice Address - Fax:406-657-4945
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP LCPC LIC 7403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional