MEDICARE: EMILY JANE PRAY M.S.W.

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	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-7857	MT

General Provider Information

NPI Number	:	1649558693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JANE PRAY M.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 5931
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59806-5931
Country	:	US
Telephone Number	:	406-241-4769
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 W ALDER ST STE 10
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4099
Country	:	US
Telephone Number	:	406-241-4769
Fax Number	:

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	02/27/2018

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