MEDICARE: MS. TERESA MAIJA LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1198-LCPC	MT
2	101YP2500X	Professional Counselor	1198	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003920646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA MAIJA LCPC

Provider Business Mailing Address
First Line	:	400 W MAIN ST STE 203
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-2443
Country	:	US
Telephone Number	:	406-837-2872
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 N 4TH ST
Second Line	:	SUITE A
City	:	HAMILTON
State	:	MT
Zip	:	59840-2412
Country	:	US
Telephone Number	:	406-363-5410
Fax Number	:	406-363-4498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/16/2018

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