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General NPI Number Information
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NPI Number | 1760876957
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Entity Type | Individual
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Provider Name | MARY DEVLIN-MCKAY LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 1018 BURLINGTON AVE STE 206
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City | MISSOULA
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State | MT
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Zip | 59801-5666
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Country | US
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Telephone | 443-223-6358
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Fax |
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Provider Business Mailing Address
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Address Line | 401 OAK ST
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City | MISSOULA
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State | MT
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Zip | 59801-2323
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Country | US
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Telephone | 443-223-6358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11475
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License Number State | MT
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