Healthcare Provider Details

I. General information

NPI: 1508022542
Provider Name (Legal Business Name): LAURA MARIE LEGAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARIE SEITZ LCPC

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 41ST AVE NE
GREAT FALLS MT
59404-6808
US

IV. Provider business mailing address

120 41ST AVE NE
GREAT FALLS MT
59404-6808
US

V. Phone/Fax

Practice location:
  • Phone: 406-930-0841
  • Fax:
Mailing address:
  • Phone: 406-930-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2323
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2323
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: