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General NPI Number Information
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NPI Number | 1861875668
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Entity Type | Organization
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Legal Business Name | MARK FERRITER LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE STE. # 208
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City | MISSOULA
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State | MT
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Zip | 59801-5674
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Country | US
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Telephone | 406-461-6784
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Fax |
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Provider Business Mailing Address
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Address Line | 800 KENSINGTON AVE STE. # 208
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City | MISSOULA
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State | MT
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Zip | 59801-5674
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Country | US
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Telephone | 406-461-6784
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Fax |
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Authorized Official
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Title or Position | MEMBER/PROVIDER
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Name | MARK FERRITER
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Credential | LCSW
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Telephone | 406-461-6784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SWP-LCSW-LIC-8872
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License Number State | MT
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