Provider Demographics
NPI:1295224376
Name:GAINAN, ANGELA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:GAINAN
Suffix:
Gender:F
Credentials:LCSW
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 219
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-0219
Mailing Address - Country:US
Mailing Address - Phone:406-252-5658
Mailing Address - Fax:406-238-3617
Practice Address - Street 1:1245 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0122
Practice Address - Country:US
Practice Address - Phone:406-252-5658
Practice Address - Fax:406-238-3617
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1891781787Medicaid