Provider Demographics
NPI:1124418181
Name:BRAULICK, MONICA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:BRAULICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2826
Mailing Address - Country:US
Mailing Address - Phone:406-380-2258
Mailing Address - Fax:
Practice Address - Street 1:207 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2718
Practice Address - Country:US
Practice Address - Phone:406-380-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-8433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81-0262019OtherYBGR