MEDICARE: MR. DAVID GAUTHIER MA

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	0680000037	VT

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
2	9993	OTHER	VT	BCBS

General Provider Information

NPI Number	:	1104997279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID GAUTHIER MA

Provider Business Mailing Address
First Line	:	432 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 MAIN ST
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-1338
Country	:	US
Telephone Number	:	802-655-3311
Fax Number	:

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	07/08/2007

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