Provider Demographics
NPI:1992167175
Name:PIKE, MARY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PIKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12775 MEDICINE MAN TRL
Mailing Address - Street 2:
Mailing Address - City:MOLT
Mailing Address - State:MT
Mailing Address - Zip Code:59057-2187
Mailing Address - Country:US
Mailing Address - Phone:406-690-4188
Mailing Address - Fax:406-657-3945
Practice Address - Street 1:1045 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0733
Practice Address - Country:US
Practice Address - Phone:406-657-3988
Practice Address - Fax:406-657-3945
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical