MEDICARE: CLARE MAGUIRE 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	BBH-LCPC-LIC-33188	MT

General Provider Information

NPI Number	:	1013579143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE MAGUIRE LCPC

Provider Business Mailing Address
First Line	:	1945 S 11TH ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-4831
Country	:	US
Telephone Number	:	406-360-0443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 S 3RD ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-1328
Country	:	US
Telephone Number	:	406-360-0443
Fax Number	:

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	06/28/2019

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Directions to “ CLARE MAGUIRE LCPC” Practice Location

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