MEDICARE: DR. MICHAEL A EMERSON PH.D.

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	101YM0800X	Mental Health Counselor	470 LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74953	OTHER	MT	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1013986348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A EMERSON PH.D.

Provider Business Mailing Address
First Line	:	11 FRIENDSHIP LN
Second Line	:	SUITE 202
City	:	MONTANA CITY
State	:	MT
Zip	:	59634-9804
Country	:	US
Telephone Number	:	406-495-0956
Fax Number	:	406-442-8090

Provider Business Practice Location Address
First Line	:	11 FRIENDSHIP LN
Second Line	:	SUITE 202
City	:	MONTANA CITY
State	:	MT
Zip	:	59634-9804
Country	:	US
Telephone Number	:	406-495-0956
Fax Number	:	406-442-8090

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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