Provider Demographics
NPI:1184837577
Name:ALEXINE, MARY (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ALEXINE
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SHADY RIVER LN
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8200
Mailing Address - Country:US
Mailing Address - Phone:406-290-9344
Mailing Address - Fax:
Practice Address - Street 1:723 5TH AVE E STE 138
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5326
Practice Address - Country:US
Practice Address - Phone:406-290-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT866101YA0400X
MT662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)