Provider Demographics
NPI:1518782895
Name:MAGGIO, ELISE (LCPC)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MAGGIO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2934
Mailing Address - Country:US
Mailing Address - Phone:512-410-9848
Mailing Address - Fax:
Practice Address - Street 1:411 N MONTANA ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3300
Practice Address - Country:US
Practice Address - Phone:512-410-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT74982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health