Provider Demographics
NPI:1316003932
Name:MYER, DEEANN MARIE (MS, LCSW)
Entity type:Individual
Prefix:
First Name:DEEANN
Middle Name:MARIE
Last Name:MYER
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 TRAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:406-586-5488
Practice Address - Street 1:515 E CALLENDER ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2716
Practice Address - Country:US
Practice Address - Phone:406-222-3576
Practice Address - Fax:406-222-3578
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT500633Medicaid