Healthcare Provider Details

I. General information

NPI: 1902147143
Provider Name (Legal Business Name): MARY E PALMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BASIN CREEK RD
BUTTE MT
59701-9704
US

IV. Provider business mailing address

115 NURSE COOK RD
BROWNING MT
59417-1135
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-6314
  • Fax: 406-494-1724
Mailing address:
  • Phone: 406-338-2735
  • Fax: 406-338-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4434
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: