Provider Demographics
NPI:1477097772
Name:BOICH, MALLORY (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BOICH
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 JACKRABBIT LN STE 3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5717
Mailing Address - Country:US
Mailing Address - Phone:847-903-5123
Mailing Address - Fax:
Practice Address - Street 1:2725 JACKRABBIT LN STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5717
Practice Address - Country:US
Practice Address - Phone:847-903-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional