Provider Demographics
NPI:1356499479
Name:MARONICK, ELAINE (ELAINE MARONICK)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MARONICK
Suffix:
Gender:F
Credentials:ELAINE MARONICK
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:MARONICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:7 W 6TH AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5072
Mailing Address - Country:US
Mailing Address - Phone:406-442-9270
Mailing Address - Fax:406-447-4255
Practice Address - Street 1:7 W 6TH AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5072
Practice Address - Country:US
Practice Address - Phone:406-442-9270
Practice Address - Fax:406-447-4255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional