Provider Demographics
NPI:1780187807
Name:DOSCH, GINA (LCPC, ACLC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DOSCH
Suffix:
Gender:F
Credentials:LCPC, ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 BIRCH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VALIER
Mailing Address - State:MT
Mailing Address - Zip Code:59486-5469
Mailing Address - Country:US
Mailing Address - Phone:406-531-7729
Mailing Address - Fax:
Practice Address - Street 1:5508 BIRCH CREEK RD
Practice Address - Street 2:
Practice Address - City:VALIER
Practice Address - State:MT
Practice Address - Zip Code:59486-5469
Practice Address - Country:US
Practice Address - Phone:406-531-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-29955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional