Provider Demographics
NPI:1023232634
Name:FICHTNER, LYNDA M (LCSW, LAC)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:M
Last Name:FICHTNER
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY ST STE 608
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4597
Mailing Address - Country:US
Mailing Address - Phone:406-360-1946
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY ST STE 608
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4597
Practice Address - Country:US
Practice Address - Phone:406-360-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC 1036101YA0400X
MTLCSW 6831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT71735OtherBLUE CROSS BLUE SHIELD MT
MT0042107Medicaid