MEDICARE: WILLOW JO ROSSMILLER 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	1269 LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000744320	OTHER	MT	BCBS

General Provider Information

NPI Number	:	1245332295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLOW JO ROSSMILLER LCPC

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59403-0457
Country	:	US
Telephone Number	:	406-453-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 2ND AVE N
Second Line	:	STE 650
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3259
Country	:	US
Telephone Number	:	406-453-3384
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	01/14/2010

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