MEDICARE: BRIANNA GRISMER LAC, MSW INTERN

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	BABH-LAC-LIC-82732	MT

General Provider Information

NPI Number	:	1992642698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA GRISMER LAC, MSW INTERN

Provider Business Mailing Address
First Line	:	1219 CENTRAL AVE
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3777
Country	:	US
Telephone Number	:	406-866-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 CENTRAL AVE
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3777
Country	:	US
Telephone Number	:	406-866-0350
Fax Number	:

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

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

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