Healthcare Provider Details

I. General information

NPI: 1508413840
Provider Name (Legal Business Name): MARSHAL GEORGE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S 21ST AVE
BOZEMAN MT
59718-5032
US

IV. Provider business mailing address

1001 S MAIN ST # 12680
KALISPELL MT
59901-1498
US

V. Phone/Fax

Practice location:
  • Phone: 406-518-1892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-PSY-LIC-5103
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: