Individual
LARA MATTSON RADLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.P.C.
Contact information
Practice address
1515 E BROADWAY ST, MISSOULA, MT 59802-4929
(406) 728-2662
(406) 728-2879
Mailing address
1515 E BROADWAY ST, MISSOULA, MT 59802-4929
(406) 728-2662
(406) 728-2879
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1462-LCPC
MT
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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