Provider Demographics
NPI:1821794355
Name:LYGA, MARK BERNARD (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BERNARD
Last Name:LYGA
Suffix:
Gender:M
Credentials:LCSW
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 6
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0006
Mailing Address - Country:US
Mailing Address - Phone:406-270-5713
Mailing Address - Fax:
Practice Address - Street 1:2504 TRADEWINDS WAY
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9707
Practice Address - Country:US
Practice Address - Phone:406-270-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-62363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health