=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679132104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMERALD JOYDELLE PARISI LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2019
-----------------------------------------------------
Last Update Date | 06/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E DIVISION ST
-----------------------------------------------------
City | HARLOWTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59036-5157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-220-0707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 RED FOX RD
-----------------------------------------------------
City | JUDITH GAP
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59453-8201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-220-0707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | BBH-LCSW-LIC-38036
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------