Provider Demographics
NPI:1093054488
Name:MAY, MARIE (PHD, LCPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC
Other - Prefix:DR
Other - First Name:GLADYS
Other - Middle Name:MARIE
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCPC, NCC
Mailing Address - Street 1:711 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-3101
Mailing Address - Country:US
Mailing Address - Phone:406-676-0055
Mailing Address - Fax:406-676-0055
Practice Address - Street 1:711 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-3101
Practice Address - Country:US
Practice Address - Phone:406-676-0055
Practice Address - Fax:406-676-0055
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNCC 315638101YM0800X
MTLCPC 2436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health