Provider Demographics
NPI:1417371915
Name:MARSH, MARY (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MARSH
Suffix:
Gender:
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-0142
Mailing Address - Country:US
Mailing Address - Phone:406-788-1164
Mailing Address - Fax:
Practice Address - Street 1:712 13TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2344
Practice Address - Country:US
Practice Address - Phone:406-788-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1368101YA0400X
MT69983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)