Provider Demographics
NPI:1154469419
Name:MAIER, KERRY S (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:S
Last Name:MAIER
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 RUNYON DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTON
Mailing Address - State:MT
Mailing Address - Zip Code:59820-9412
Mailing Address - Country:US
Mailing Address - Phone:406-722-4572
Mailing Address - Fax:
Practice Address - Street 1:126 E BROADWAY ST STE 10
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4566
Practice Address - Country:US
Practice Address - Phone:406-239-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT885 LCP101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional