Provider Demographics
NPI:1891822961
Name:GOSNEY, VIRGINIA (LAC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:GOSNEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-2958
Mailing Address - Country:US
Mailing Address - Phone:406-761-6148
Mailing Address - Fax:
Practice Address - Street 1:1210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3152
Practice Address - Country:US
Practice Address - Phone:406-873-2155
Practice Address - Fax:406-873-2155
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT760740OtherBLUECROSS BLUESHIELD
MT760740OtherBLUECHIP