Healthcare Provider Details

I. General information

NPI: 1083864359
Provider Name (Legal Business Name): MARY LOUISE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DEWEY BLVD STE B
BUTTE MT
59701-3214
US

IV. Provider business mailing address

600 DEWEY BLVD STE B
BUTTE MT
59701-3214
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-4778
  • Fax: 406-782-1318
Mailing address:
  • Phone: 406-782-4778
  • Fax: 406-782-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1383
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: