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NPI Code Detail

MEDICARE: MOUNTAIN CREST COUNSELING PC

MEDICARE: MOUNTAIN CREST COUNSELING PC
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
11041C0700XClinical Social Worker4923MT

General Provider Information

NPI Number : 1437693835
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN CREST COUNSELING PC
Provider Business Mailing Address
First Line : PO BOX 243
Second Line :
City : HAMILTON
State : MT
Zip : 59840-0243
Country : US
Telephone Number : 406-880-2352
Fax Number :
Provider Business Practice Location Address
First Line : 310 N 4TH ST
Second Line : SUITE D
City : HAMILTON
State : MT
Zip : 59840-2412
Country : US
Telephone Number : 406-880-2352
Fax Number :
Authorized Official
Title or Position : SHAREHOLDER/ THERAPIST
Name : REBECCA E MANN
Credential : LCSW
Telephone Number : 406-880-2352
Provider Enumeration Date : 12/05/2016
Last Update Date : 12/05/2016

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Directions to “MOUNTAIN CREST COUNSELING PC ” Practice Location

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