Provider Demographics
NPI:1073677084
Name:MCGRADE, NANCY (LAC, LCPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MCGRADE
Suffix:
Gender:F
Credentials:LAC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 HWY 212
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070
Mailing Address - Country:US
Mailing Address - Phone:406-254-8618
Mailing Address - Fax:
Practice Address - Street 1:1 N BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-254-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT529101YA0400X
MT398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0250869Medicaid
MT76560OtherBLUECROSSBLUESHIELD