Healthcare Provider Details

I. General information

NPI: 1124785126
Provider Name (Legal Business Name): ALICE FAYE MAINWARING SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 OLD CORVALLIS RD STE W
HAMILTON MT
59840-3213
US

IV. Provider business mailing address

PO BOX 622
HAMILTON MT
59840-0622
US

V. Phone/Fax

Practice location:
  • Phone: 406-241-5755
  • Fax:
Mailing address:
  • Phone: 406-207-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-90146
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-50372
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: