MEDICARE: ELISE MAGGIO 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	101YM0800X	Mental Health Counselor	74982	MT

General Provider Information

NPI Number	:	1518782895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE MAGGIO LCPC

Provider Business Mailing Address
First Line	:	420 N PACIFIC ST
Second Line	:
City	:	DILLON
State	:	MT
Zip	:	59725-2934
Country	:	US
Telephone Number	:	512-410-9848
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 N MONTANA ST
Second Line	:
City	:	DILLON
State	:	MT
Zip	:	59725-3300
Country	:	US
Telephone Number	:	512-410-9848
Fax Number	:

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

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “ ELISE MAGGIO LCPC” Practice Location

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