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General NPI Number Information
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NPI Number | 1659545168
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Entity Type | Organization
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Legal Business Name | LYNN MARIE GROSULAK LCPC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 710 GRAND AVE SUITE 6
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City | BILLINGS
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State | MT
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Zip | 59101-5852
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Country | US
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Telephone | 406-855-9446
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Fax | 406-294-0967
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Provider Business Mailing Address
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Address Line | PO BOX 20794
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City | BILLINGS
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State | MT
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Zip | 59104-0794
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Country | US
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Telephone | 406-855-9446
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Fax | 406-294-0967
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Authorized Official
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Title or Position | OWNER
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Name | LYNN MARIE GROSULAK
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Credential | LCPC
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Telephone | 406-855-9446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1114 LCPC
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License Number State | MT
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