1396805404 NPI number — MARILEE PEGGY SMITH, LCPC

Table of content: (NPI 1396805404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396805404 NPI number — MARILEE PEGGY SMITH, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILEE PEGGY SMITH, LCPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396805404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED LODGE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59068-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-860-6481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 WEST 11TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED LODGE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59068-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-860-6481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MARILEE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-860-6481

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  353 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0251589 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74891 . This is a "BLUE CROSS-SHIELD OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com