Provider Demographics
NPI:1346570652
Name:WITTHAR, MARIAN (LCPC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:WITTHAR
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 1:333 HAGGERTY LN
Mailing Address - Street 2:5
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1779
Mailing Address - Country:US
Mailing Address - Phone:406-586-7760
Mailing Address - Fax:406-585-3434
Practice Address - Street 1:333 HAGGERTY LN
Practice Address - Street 2:5
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1779
Practice Address - Country:US
Practice Address - Phone:406-586-7760
Practice Address - Fax:406-585-3434
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT74628OtherBLUE CROSS/BLUE SHIELD