Provider Demographics
NPI:1992524441
Name:FISCHER, RONALD GLENN (LAC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GLENN
Last Name:FISCHER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W GALENA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1507
Mailing Address - Country:US
Mailing Address - Phone:406-640-8069
Mailing Address - Fax:406-303-5264
Practice Address - Street 1:609 W GALENA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1507
Practice Address - Country:US
Practice Address - Phone:406-640-8069
Practice Address - Fax:406-303-5264
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-59866101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)