Healthcare Provider Details

I. General information

NPI: 1881354744
Provider Name (Legal Business Name): D'ANN GRACE GAREIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HODGSON RD
COLUMBIA FALLS MT
59912-9063
US

IV. Provider business mailing address

390 HODGSON RD
COLUMBIA FALLS MT
59912-9063
US

V. Phone/Fax

Practice location:
  • Phone: 406-897-2788
  • Fax:
Mailing address:
  • Phone: 406-897-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number46837
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: