Healthcare Provider Details

I. General information

NPI: 1396805404
Provider Name (Legal Business Name): MARILEE PEGGY SMITH, LCPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WEST 11TH
RED LODGE MT
59068-1311
US

IV. Provider business mailing address

PO BOX 1311
RED LODGE MT
59068-1311
US

V. Phone/Fax

Practice location:
  • Phone: 406-860-6481
  • Fax:
Mailing address:
  • Phone: 406-860-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number353
License Number StateMT

VIII. Authorized Official

Name: MRS. MARILEE D. SMITH
Title or Position: OWNER
Credential: LCPC
Phone: 406-860-6481