Provider Demographics
NPI:1013779909
Name:FRIERSON, MICHELLE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2755
Mailing Address - Country:US
Mailing Address - Phone:406-222-2812
Mailing Address - Fax:
Practice Address - Street 1:430 E PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2755
Practice Address - Country:US
Practice Address - Phone:406-222-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MTBBH-LAC-LIC-64721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)