Provider Demographics
NPI:1306334925
Name:GOOD LUCK, CHRISTINE L (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:GOOD LUCK
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0175
Mailing Address - Country:US
Mailing Address - Phone:406-679-5360
Mailing Address - Fax:406-794-0408
Practice Address - Street 1:101 BAACHEEITCHE AVE.
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-679-5360
Practice Address - Fax:406-794-0408
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)