MEDICARE: LORRI L DENTON 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	472LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74486	OTHER	MT	BLUE CROSS BLUE SHIELD
2	75363	OTHER	MT	BLUE CROSS BLUE SHIELD
3	741840	OTHER	MT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1407842388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRI L DENTON LCPC

Provider Business Mailing Address
First Line	:	26 WEST MAIN ST
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072
Country	:	US
Telephone Number	:	406-323-1142
Fax Number	:	406-323-1149

Provider Business Practice Location Address
First Line	:	26 WEST MAIN ST
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072
Country	:	US
Telephone Number	:	406-323-1142
Fax Number	:	406-323-1149

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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