MEDICARE: CHOUTEAU COUNTY

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	196	MT

General Provider Information

NPI Number	:	1629114624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOUTEAU COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 1167
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-1167
Country	:	US
Telephone Number	:	406-622-3211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 FRANKLIN STREET
Second Line	:
City	:	FORT BENTON
State	:	MT
Zip	:	59442-0459
Country	:	US
Telephone Number	:	406-622-3211
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. CAROL GEORGEANNE RICHARD
Credential	:	LAC
Telephone Number	:	406-622-3211

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	11/20/2007

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Directions to “CHOUTEAU COUNTY ” Practice Location

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