Healthcare Provider Details

I. General information

NPI: 1871566513
Provider Name (Legal Business Name): MARY LOUISE MEIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MAIN ST 2ND FLOOR
SHELBY MT
59474-1910
US

IV. Provider business mailing address

PO BOX 573
SHELBY MT
59474-0573
US

V. Phone/Fax

Practice location:
  • Phone: 406-434-5276
  • Fax: 406-424-2714
Mailing address:
  • Phone: 406-434-5276
  • Fax: 406-424-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number196
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: