MEDICARE: MS. COE A DOLVEN MA 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1235298837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COE A DOLVEN MA LCPC

Provider Business Mailing Address
First Line	:	3700 S RUSSELL ST STE B110
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-541-7324
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 S RUSSELL ST STE B110
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-541-7324
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	12/04/2024

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