MEDICARE: ELAINE MARONICK ELAINE MARONICK

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	663	MT

General Provider Information

NPI Number	:	1356499479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE MARONICK ELAINE MARONICK

Provider Business Mailing Address
First Line	:	7 W 6TH AVE
Second Line	:	SUITE 512
City	:	HELENA
State	:	MT
Zip	:	59601-5072
Country	:	US
Telephone Number	:	406-442-9270
Fax Number	:	406-447-4255

Provider Business Practice Location Address
First Line	:	7 W 6TH AVE
Second Line	:	SUITE 512
City	:	HELENA
State	:	MT
Zip	:	59601-5072
Country	:	US
Telephone Number	:	406-442-9270
Fax Number	:	406-447-4255

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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