Provider Demographics
NPI:1700312865
Name:GAINES, DESIREE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:MARIE
Last Name:GAINES
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 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-761-2100
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:5305 3RD AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/CHIEF JOSEPH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1719
Practice Address - Country:US
Practice Address - Phone:406-761-2100
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT239911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0705113OtherBLUE CROSS-SHIELD OF MONTANA