MEDICARE: ROSLYN MARY GALLAGHER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	757 LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000075378	OTHER	MT	BLUE CROSS/SHIELD OF MONT

General Provider Information

NPI Number	:	1013986561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSLYN MARY GALLAGHER LCPC

Provider Business Mailing Address
First Line	:	104 2ND ST S STE 20
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3600
Country	:	US
Telephone Number	:	406-899-0865
Fax Number	:

Provider Business Practice Location Address
First Line	:	104-2ND STREET S., STE. 20
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3600
Country	:	US
Telephone Number	:	406-899-0865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	02/18/2015

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