MEDICARE: BROOKE OLIVIA BEIGHLE MA, PCLC, NCC

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	BBH-PCLC-LIC-72524	MT

General Provider Information

NPI Number	:	1801621966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE OLIVIA BEIGHLE MA, PCLC, NCC

Provider Business Mailing Address
First Line	:	2721 CONNERY WAY
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 CONNERY WAY
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1951
Country	:	US
Telephone Number	:	406-219-1267
Fax Number	:	855-975-3095

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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