MEDICARE: MRS. EMILY ANN KRUSHEFSKI 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	941	MT

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
2	744593	OTHER	MT	BLUE CHIP PROVIDER ID

General Provider Information

NPI Number	:	1154434827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY ANN KRUSHEFSKI LCPC

Provider Business Mailing Address
First Line	:	1940 W DICKERSON ST
Second Line	:	SUITE 102
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-522-0410
Fax Number	:	406-587-2292

Provider Business Practice Location Address
First Line	:	1940 W DICKERSON ST
Second Line	:	SUITE 102
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-522-0410
Fax Number	:	406-587-2292

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/09/2015

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