MEDICARE: ELISABETH MONTANA PURDY 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	LCPC 1189	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GROUP	OTHER	MT	GROUP DEFAULT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477550549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH MONTANA PURDY LCPC

Provider Business Mailing Address
First Line	:	120 23RD AVE NE
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-1445
Country	:	US
Telephone Number	:	406-453-6784
Fax Number	:	406-453-6793

Provider Business Practice Location Address
First Line	:	120 23RD AVE NE
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-1445
Country	:	US
Telephone Number	:	406-453-6784
Fax Number	:	406-453-6793

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/09/2008

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