Provider Demographics
NPI:1730406281
Name:SAIC
Entity type:Organization
Organization Name:SAIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADOLESCENT COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:406-329-4501
Mailing Address - Street 1:PSC 476 BOX 62
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322-0001
Mailing Address - Country:US
Mailing Address - Phone:8195-628-1371
Mailing Address - Fax:
Practice Address - Street 1:PSC 476 BOX 62
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96322-0001
Practice Address - Country:US
Practice Address - Phone:8195-628-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6754286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital