Provider Demographics
NPI:1558795120
Name:SEEFELDT, MARYJANE (LCPC, LAC)
Entity type:Individual
Prefix:MS
First Name:MARYJANE
Middle Name:
Last Name:SEEFELDT
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:MARYJANE
Other - Middle Name:
Other - Last Name:MOLDENHAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1021
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-1021
Mailing Address - Country:US
Mailing Address - Phone:406-249-1902
Mailing Address - Fax:
Practice Address - Street 1:601 PARK AVE APT 20
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2788
Practice Address - Country:US
Practice Address - Phone:406-249-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2020-10-15
Deactivation Date:2019-12-23
Deactivation Code:
Reactivation Date:2020-02-21
Provider Licenses
StateLicense IDTaxonomies
MT41347101YA0400X
MT44231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)