Healthcare Provider Details

I. General information

NPI: 1215944335
Provider Name (Legal Business Name): SYLVIA MAHR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA JESSOP

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 ROOSEVELT LN
HAMILTON MT
59840-3326
US

IV. Provider business mailing address

PO BOX 196
CORVALLIS MT
59828-0196
US

V. Phone/Fax

Practice location:
  • Phone: 406-370-8341
  • Fax:
Mailing address:
  • Phone: 406-370-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number584
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: