Provider Demographics
NPI:1194028621
Name:MOLLOY, MOLLY M (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:M
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 FLORAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4620
Mailing Address - Country:US
Mailing Address - Phone:406-360-7439
Mailing Address - Fax:
Practice Address - Street 1:55 BASIN CREEK RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9704
Practice Address - Country:US
Practice Address - Phone:406-533-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical