Provider Demographics
NPI:1144380528
Name:HARSH, MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:HARSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N LAST CHANCE GULCH
Mailing Address - Street 2:STE 203
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4121
Mailing Address - Country:US
Mailing Address - Phone:406-449-4800
Mailing Address - Fax:406-449-1393
Practice Address - Street 1:101 N LAST CHANCE GULCH
Practice Address - Street 2:STE 203
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4121
Practice Address - Country:US
Practice Address - Phone:406-465-6793
Practice Address - Fax:406-442-5868
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT52221OtherBLUE CROSS BLUE SHIELD
MT0492150Medicaid
MT0492150Medicaid