MEDICARE: MRS. DEBRA ANN NEESE PCLC

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	30125	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BBH-PCLC-LIC-30125	OTHER	MT	BOARD OF BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1093211674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANN NEESE PCLC

Provider Business Mailing Address
First Line	:	PO BOX 50625
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-0625
Country	:	US
Telephone Number	:	406-690-4743
Fax Number	:	406-534-2367

Provider Business Practice Location Address
First Line	:	1116 GRAND AVE STE 303
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-4282
Country	:	US
Telephone Number	:	406-690-4743
Fax Number	:	406-534-2367

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	06/16/2018

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