Healthcare Provider Details

I. General information

NPI: 1619287695
Provider Name (Legal Business Name): MARCIA JO THARP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RIVER RD
KALISPELL MT
59901-2823
US

IV. Provider business mailing address

14 RIVER RD
KALISPELL MT
59901-2823
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-8721
  • Fax: 406-257-4054
Mailing address:
  • Phone: 406-756-8721
  • Fax: 406-257-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number973-LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: