Provider Demographics
NPI:1174182521
Name:MAGDALENE, CHRISTINE (LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MAGDALENE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1526
Mailing Address - Country:US
Mailing Address - Phone:406-531-3567
Mailing Address - Fax:
Practice Address - Street 1:65 E BROADWAY ST STE 426
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9305
Practice Address - Country:US
Practice Address - Phone:406-531-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-37820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCPC-LIC-37820OtherMONTANA BOARD OF BEHAVIORAL HEALTH