Provider Demographics
NPI:1023460490
Name:FORTNER, STACY ANN (LCPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:FORTNER
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 1:205 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2340
Mailing Address - Country:US
Mailing Address - Phone:406-563-8117
Mailing Address - Fax:406-563-5956
Practice Address - Street 1:205 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2340
Practice Address - Country:US
Practice Address - Phone:406-563-8117
Practice Address - Fax:406-563-5956
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional