1396816724 NPI number — LYNN GROSULAK LCPC

Table of content: LYNN GROSULAK LCPC (NPI 1396816724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396816724 NPI number — LYNN GROSULAK LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSULAK
Provider First Name:
LYNN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396816724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20794
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59104-0794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-855-9446
Provider Business Mailing Address Fax Number:
406-294-0967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE #6
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-5852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-855-9446
Provider Business Practice Location Address Fax Number:
406-294-0967
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1114LCPC , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0256173 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000741370 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com