Basic Information
| Provider Information | |||||||||
| NPI: | 1376058271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAGG | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 928 FIGHTIN IRISH WAY UNIT 2 | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591062664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063904931 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1732 S 72ND ST W | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591063538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066513100 | ||||||||
| FaxNumber: | 4062567026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2017 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | BBH-PCLC-LIC-24238 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.