Provider Demographics
NPI:1215944095
Name:LEE, MARY F (LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:LEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7804
Mailing Address - Country:US
Mailing Address - Phone:406-543-9700
Mailing Address - Fax:
Practice Address - Street 1:1184 N 15TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3291
Practice Address - Country:US
Practice Address - Phone:406-586-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health