MEDICARE: MS. CHARLOTTE DICKSON 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	878	MT

General Provider Information

NPI Number	:	1801944251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLOTTE DICKSON LCPC

Provider Business Mailing Address
First Line	:	1940 W DICKERSON ST STE 205
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-580-0806
Fax Number	:	406-585-6934

Provider Business Practice Location Address
First Line	:	1940 W DICKERSON ST STE 205
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-580-0806
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	10/17/2023

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