MEDICARE: LISA MATOVICH BROOKE COUNSELING INC

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144781212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA MATOVICH BROOKE COUNSELING INC

Provider Business Mailing Address
First Line	:	512 N 29TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 N 29TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1113
Country	:	US
Telephone Number	:	406-672-7904
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA MATOVICH-BROOKE
Credential	:
Telephone Number	:	406-672-7904

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	07/05/2024

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