MEDICARE: JOSHUA JAMES PATE-TERRY LCSW

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	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-48630	MT

General Provider Information

NPI Number	:	1780266619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JAMES PATE-TERRY LCSW

Provider Business Mailing Address
First Line	:	3703 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-6897
Country	:	US
Telephone Number	:	406-533-3207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 HARRISON AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-6897
Country	:	US
Telephone Number	:	406-533-3207
Fax Number	:

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	03/14/2022

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