Provider Demographics
NPI:1063456895
Name:GILLEO, BRETT E (LCPC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:E
Last Name:GILLEO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6451
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406
Mailing Address - Country:US
Mailing Address - Phone:406-240-2045
Mailing Address - Fax:406-545-2276
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:SUITE 342
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-240-2045
Practice Address - Fax:406-545-2276
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 1009103TC1900X
MTLCPC1009101Y00000X, 106H00000X
101Y00000X, 103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000742490OtherBC BS
MT0256854Medicaid