MEDICARE: DEBRA PERRIGO

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	995	MT
2	101YP2500X	Professional Counselor	19621	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0761990	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1619035078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA PERRIGO

Provider Business Mailing Address
First Line	:	308 E 1ST ST
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-3049
Country	:	US
Telephone Number	:	406-628-2579
Fax Number	:	406-628-2596

Provider Business Practice Location Address
First Line	:	308 E 1ST ST
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-3049
Country	:	US
Telephone Number	:	406-628-2579
Fax Number	:	406-628-2596

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/23/2016

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Directions to “ DEBRA PERRIGO ” Practice Location

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