MEDICARE: MOLLY BASTA 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

General Provider Information

NPI Number	:	1952841843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY BASTA LCPC

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	BINGEN
State	:	WA
Zip	:	98605-0069
Country	:	US
Telephone Number	:	406-813-1621
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 1ST AVE E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4935
Country	:	US
Telephone Number	:	406-813-1621
Fax Number	:

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	03/22/2025

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