MEDICARE: VIRGINIA WARNER 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	101YP2500X	Professional Counselor	SWP-LCPC-LIC-4698	MT

General Provider Information

NPI Number	:	1831525294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA WARNER LCPC

Provider Business Mailing Address
First Line	:	119 1/2 W PARK ST
Second Line	:	SUITE 4
City	:	LIVINGSTON
State	:	MT
Zip	:	59047-2661
Country	:	US
Telephone Number	:	406-570-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 1/2 W PARK ST
Second Line	:	SUITE 4
City	:	LIVINGSTON
State	:	MT
Zip	:	59047-2661
Country	:	US
Telephone Number	:	406-570-8337
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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