MEDICARE: GABRIEL C D'LUZANSKY 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	101YM0800X	Mental Health Counselor	BBH-LCPC-LIC-79159	MT

General Provider Information

NPI Number	:	1174319446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL C D'LUZANSKY LCPC

Provider Business Mailing Address
First Line	:	815 PARK AVE
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-2833
Country	:	US
Telephone Number	:	928-707-0613
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 2ND ST E STE 204
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4500
Country	:	US
Telephone Number	:	928-707-0613
Fax Number	:

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

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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