Provider Demographics
NPI:1184995425
Name:JARACZESKI, PATRICIA L (LAC, BSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:JARACZESKI
Suffix:
Gender:F
Credentials:LAC, BSW
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 3126 26 4TH ST N
Mailing Address - Street 2:GATEWAY COMMUNITY SERVICES
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401
Mailing Address - Country:US
Mailing Address - Phone:406-727-2512
Mailing Address - Fax:406-727-7451
Practice Address - Street 1:26 4TH ST. N.
Practice Address - Street 2:GATEWAY COMMUNITY SERVICES
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3522
Practice Address - Country:US
Practice Address - Phone:406-454-6930
Practice Address - Fax:406-454-6939
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT830101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)