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NPI Code Detail

MEDICARE: VIRGINIA GOSNEY LAC

MEDICARE: VIRGINIA GOSNEY LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1072MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1760740OTHERMTBLUECROSS BLUESHIELD
2760740OTHERMTBLUECHIP

General Provider Information

NPI Number : 1891822961
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA GOSNEY LAC
Provider Business Mailing Address
First Line : 320 6TH ST SW
Second Line :
City : GREAT FALLS
State : MT
Zip : 59404-2958
Country : US
Telephone Number : 406-761-6148
Fax Number :
Provider Business Practice Location Address
First Line : 1210 E MAIN ST
Second Line :
City : CUT BANK
State : MT
Zip : 59427-3152
Country : US
Telephone Number : 406-873-2155
Fax Number : 406-873-2155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 07/08/2007

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Directions to “ VIRGINIA GOSNEY LAC” Practice Location

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