Provider Demographics
NPI:1083864359
Name:WATSON, MARY LOUISE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DEWEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3214
Mailing Address - Country:US
Mailing Address - Phone:406-782-4778
Mailing Address - Fax:406-782-1318
Practice Address - Street 1:600 DEWEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3214
Practice Address - Country:US
Practice Address - Phone:406-782-4778
Practice Address - Fax:406-782-1318
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT135106H00000X
MT1383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist