Provider Demographics
NPI:1437868189
Name:LIDBERG, MEGHAN CHRISTINE (LADC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:CHRISTINE
Last Name:LIDBERG
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 ELK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILSALL
Mailing Address - State:MT
Mailing Address - Zip Code:59086-9456
Mailing Address - Country:US
Mailing Address - Phone:763-234-4051
Mailing Address - Fax:
Practice Address - Street 1:126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2624
Practice Address - Country:US
Practice Address - Phone:406-222-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-71150101YA0400X
MN2983101YP2500X
MTBBH-LCPC-LIC-72310101YM0800X
MN306290101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional