Basic Information
| Provider Information | |||||||||
| NPI: | 1235293358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYRDAHL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 S JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PLENTYWOOD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 592542038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067652550 | ||||||||
| FaxNumber: | 4067653488 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 S JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PLENTYWOOD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 592542038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067652550 | ||||||||
| FaxNumber: | 4067653488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 870 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.