Provider Demographics
NPI:1356343842
Name:FISCUS, ANDREA SENTENEY (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SENTENEY
Last Name:FISCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:SENTENEY
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 20976
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-0976
Mailing Address - Country:US
Mailing Address - Phone:406-671-0454
Mailing Address - Fax:
Practice Address - Street 1:1643 24TH ST W
Practice Address - Street 2:SUITE 309
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2677
Practice Address - Country:US
Practice Address - Phone:406-671-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT490603Medicaid
MT000050052Medicare PIN