Healthcare Provider Details

I. General information

NPI: 1275497240
Provider Name (Legal Business Name): MARY JOHANNA MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MERCURY ST
BUTTE MT
59701-1510
US

IV. Provider business mailing address

630 W MERCURY ST
BUTTE MT
59701-1510
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-1172
  • Fax: 406-782-6964
Mailing address:
  • Phone: 406-496-1172
  • Fax: 406-782-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-70233
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: