Healthcare Provider Details

I. General information

NPI: 1063456895
Provider Name (Legal Business Name): BRETT E GILLEO LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 2ND AVE N SUITE 342
GREAT FALLS MT
59401
US

IV. Provider business mailing address

PO BOX 6451
GREAT FALLS MT
59406
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-2045
  • Fax: 406-545-2276
Mailing address:
  • Phone: 406-240-2045
  • Fax: 406-545-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLCPC 1009
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC1009
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCPC1009
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: