Provider Demographics
NPI:1952640815
Name:DALRYMPLE, GINA (LCSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DALRYMPLE
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 1:1201 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-5328
Mailing Address - Country:US
Mailing Address - Phone:406-883-1718
Mailing Address - Fax:406-204-1207
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5328
Practice Address - Country:US
Practice Address - Phone:406-883-1718
Practice Address - Fax:406-204-1207
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7770377Medicaid