Provider Demographics
NPI:1902322266
Name:RICHEM, TANYA L (MSC/ACLC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:L
Last Name:RICHEM
Suffix:
Gender:F
Credentials:MSC/ACLC, LCPC
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 1231
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-1231
Mailing Address - Country:US
Mailing Address - Phone:406-590-7837
Mailing Address - Fax:
Practice Address - Street 1:1324 CENTRAL AVE W STE 6
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3971
Practice Address - Country:US
Practice Address - Phone:406-590-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-25320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional