MEDICARE: DR. PAUL FRANCIS COURTEAU PH.D., 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	LCPC 579	MT
2	101YM0800X	Mental Health Counselor	LPC 664	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	740350	OTHER	MT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1639283666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL FRANCIS COURTEAU PH.D., LCPC

Provider Business Mailing Address
First Line	:	1105 COLLEGE ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2908
Country	:	US
Telephone Number	:	406-381-0781
Fax Number	:	406-777-2806

Provider Business Practice Location Address
First Line	:	1903 S RUSSELL ST
Second Line	:	SUITE 5
City	:	MISSOULA
State	:	MT
Zip	:	59801-6603
Country	:	US
Telephone Number	:	406-532-1615
Fax Number	:	406-532-1616

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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