MEDICARE: JO ANN GRAVES-GILL 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	101YM0800X	Mental Health Counselor	809-LCPC	MT

General Provider Information

NPI Number	:	1982756185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANN GRAVES-GILL LCPC

Provider Business Mailing Address
First Line	:	PO BOX 10251
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59904-3251
Country	:	US
Telephone Number	:	406-755-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 6TH AVE E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-5005
Country	:	US
Telephone Number	:	406-755-6760
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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