Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101Y00000X | Counselor | LCPC1009 | MT |
N | 103K00000X | Behavior Analyst | ||
N | 103TC1900X | Counseling Psychologist | LCPC 1009 | MT |
NPI | 1063456895 |
---|---|
Provider Name | Mr. Brett E Gilleo |
First Address | Great Falls, MT 59406 |
Second Address | Great Falls, MT 59401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000742490 | BC BS (01) | MT |
0256854 | (05) | MT |