Provider Demographics
NPI:1356418743
Name:TRANDAHL, DANA ANN (LCPC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ANN
Last Name:TRANDAHL
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 1:3209 FLORAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4564
Mailing Address - Country:US
Mailing Address - Phone:406-491-2550
Mailing Address - Fax:406-299-2380
Practice Address - Street 1:3209 FLORAL BLVD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4564
Practice Address - Country:US
Practice Address - Phone:406-491-2550
Practice Address - Fax:406-299-2380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0253419Medicaid