MEDICARE: MR. JEFF S. PFLUG MA, L.A.C.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1012	MT

General Provider Information

NPI Number	:	1447260799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF S. PFLUG MA, L.A.C.

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:
City	:	WARM SPRINGS
State	:	MT
Zip	:	59756-0300
Country	:	US
Telephone Number	:	406-693-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	MONTANA STATE HOSPITAL
Second Line	:
City	:	WARM SPRINGS
State	:	MT
Zip	:	59756-2119
Country	:	US
Telephone Number	:	406-693-7060
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	11/19/2014

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