MEDICARE: SAMMIE JO ANDERSON 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-LAC-LIC-64413	MT

General Provider Information

NPI Number	:	1902500960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMMIE JO ANDERSON LAC

Provider Business Mailing Address
First Line	:	11 5TH ST N STE 202
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3269
Country	:	US
Telephone Number	:	406-836-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 5TH ST N STE 202
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3269
Country	:	US
Telephone Number	:	406-836-2669
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	12/13/2024

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Directions to “ SAMMIE JO ANDERSON LAC” Practice Location

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