=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063544054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY K REPPE LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 8TH AVE N SUITE 203
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59401-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-452-1190
-----------------------------------------------------
Fax | 406-452-1190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7297
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59406-7297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-452-1190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 435
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------