Healthcare Provider Details

I. General information

NPI: 1477473957
Provider Name (Legal Business Name): MARRI LYNN MCCALLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 STADIUM DR
BOZEMAN MT
59715-0617
US

IV. Provider business mailing address

823 S CHURCH AVE
BOZEMAN MT
59715-5346
US

V. Phone/Fax

Practice location:
  • Phone: 406-624-6007
  • Fax:
Mailing address:
  • Phone: 503-989-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number88359
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: