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NPI Code Detail

MEDICARE: MR. KASEY JOSEPH NICHOLSON M.S., LAC

MEDICARE: MR. KASEY JOSEPH NICHOLSON M.S., LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1340 LACMT

General Provider Information

NPI Number : 1366711418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KASEY JOSEPH NICHOLSON M.S., LAC
Provider Business Mailing Address
First Line : 830 W CENTRAL AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7931
Country : US
Telephone Number : 406-829-9515
Fax Number : 406-829-9519
Provider Business Practice Location Address
First Line : 830 W CENTRAL AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59801-7931
Country : US
Telephone Number : 406-829-9515
Fax Number : 406-829-9519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2011
Last Update Date : 12/19/2011

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