MEDICARE: MAGGIE MOFFATT 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	541-LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	237771	OTHER	COMPSYCH CORP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7543-3	OTHER	BLUE CROSS/BLUE SHIELD
4	M4580	OTHER	APS HEALTHCARE
5	A974170	OTHER	VALUE OPTIONS

General Provider Information

NPI Number	:	1023010626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE MOFFATT LCPC

Provider Business Mailing Address
First Line	:	505 W MAIN ST
Second Line	:	SUITE 225
City	:	LEWISTOWN
State	:	MT
Zip	:	59457-5703
Country	:	US
Telephone Number	:	406-538-5990
Fax Number	:	406-538-4564

Provider Business Practice Location Address
First Line	:	505 W MAIN ST
Second Line	:	SUITE 225
City	:	LEWISTOWN
State	:	MT
Zip	:	59457-5703
Country	:	US
Telephone Number	:	406-538-5990
Fax Number	:	406-538-4564

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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