Individual
MS. LISA RAE ANDERSON MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
120 23RD AVE NE, GREAT FALLS, MT 59404-1445
(406) 453-6784
(406) 453-6793
Mailing address
120 23RD AVE NE, GREAT FALLS, MT 59404-1445
(406) 453-6784
(406) 453-6793
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC 762
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252331
—
MT
01
—
074938
BLUE CROSS BLUE SHIELD
MT
Enumeration date
06/30/2005
Last updated
04/01/2008
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