Healthcare Provider Details

I. General information

NPI: 1518082650
Provider Name (Legal Business Name): MARYANN ELIZABETH FARRIS-SATTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHEYENNE AVE BEHAVIOR HEALTH
LAME DEER MT
59043
US

IV. Provider business mailing address

PO BOX 97
LAME DEER MT
59043
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4514
  • Fax: 406-477-4513
Mailing address:
  • Phone: 406-477-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number421
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: