Provider Demographics
NPI:1285215590
Name:AMSDEN, MARIANNE JACKSON (LCPC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:JACKSON
Last Name:AMSDEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5588 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9580
Mailing Address - Country:US
Mailing Address - Phone:406-920-0888
Mailing Address - Fax:
Practice Address - Street 1:716 S 20TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6837
Practice Address - Country:US
Practice Address - Phone:406-414-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-48533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health