Healthcare Provider Details

I. General information

NPI: 1750110433
Provider Name (Legal Business Name): NANCY H MAXWELL L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 5TH AVE E., B-18
KALISPELL MT
59901
US

IV. Provider business mailing address

700 STEEL BRIDGE RD
KALISPELL MT
59901
US

V. Phone/Fax

Practice location:
  • Phone: 406-249-5506
  • Fax:
Mailing address:
  • Phone: 406-212-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-50449
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: