MEDICARE: NIEVES DEL CARMEN GONZALEZ MA, 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	15791	MT
2	101YP2500X	Professional Counselor	1640	WY
3	101YP2500X	Professional Counselor	BBH-LCPC-LIC-15791	MT

General Provider Information

NPI Number	:	1518327246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIEVES DEL CARMEN GONZALEZ MA, LCPC

Provider Business Mailing Address
First Line	:	PO BOX 812
Second Line	:
City	:	FLORENCE
State	:	MT
Zip	:	59833-0812
Country	:	US
Telephone Number	:	406-361-0444
Fax Number	:	406-273-4707

Provider Business Practice Location Address
First Line	:	9801 VALLEY GROVE DR
Second Line	:	SUITE D
City	:	LOLO
State	:	MT
Zip	:	59847-8617
Country	:	US
Telephone Number	:	406-273-4633
Fax Number	:	406-273-4707

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	10/09/2018

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