Healthcare Provider Details

I. General information

NPI: 1700051414
Provider Name (Legal Business Name): MPM SERVICE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 AVENUE D SUITE 1
BILLINGS MT
59102-3010
US

IV. Provider business mailing address

1597 AVENUE D SUITE 1
BILLINGS MT
59102-3010
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-9890
  • Fax: 406-294-0967
Mailing address:
  • Phone: 406-238-9890
  • Fax: 406-294-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number701 LCPC
License Number StateMT

VIII. Authorized Official

Name: MARY MACKI
Title or Position: OWNER
Credential: LCPC
Phone: 406-238-9890