MEDICARE: GENEVIEVE ELENA RODRIGUEZ

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-ACLC-LIC-72602	MT
2	101YM0800X	Mental Health Counselor	BBH-PCLC-LIC-72603	MT

General Provider Information

NPI Number	:	1457170086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE ELENA RODRIGUEZ

Provider Business Mailing Address
First Line	:	208 N BROADWAY STE 313
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1942
Country	:	US
Telephone Number	:	406-545-0787
Fax Number	:	406-412-0518

Provider Business Practice Location Address
First Line	:	208 N BROADWAY STE 313
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1942
Country	:	US
Telephone Number	:	406-545-0787
Fax Number	:	406-412-0518

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/17/2024

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