MEDICARE: MR. JOHN CRAIG LILBURN MSW, LCSW

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	921	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881908028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CRAIG LILBURN MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 7363
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59807-7363
Country	:	US
Telephone Number	:	406-529-2619
Fax Number	:	406-258-0491

Provider Business Practice Location Address
First Line	:	111 N HIGGINS AVE
Second Line	:	STE 422
City	:	MISSOULA
State	:	MT
Zip	:	59802-4437
Country	:	US
Telephone Number	:	406-529-2619
Fax Number	:	406-258-0491

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/23/2016

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