Provider Demographics
NPI:1366568982
Name:SMITH, MARIANNE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:SMITH
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 1:2901 W BROADWAY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1784
Mailing Address - Country:US
Mailing Address - Phone:406-370-4135
Mailing Address - Fax:406-540-4083
Practice Address - Street 1:2901 W BROADWAY ST STE 208
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1784
Practice Address - Country:US
Practice Address - Phone:406-370-4135
Practice Address - Fax:406-540-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional