Provider Demographics
NPI:1477738615
Name:MARVIN H. BACKER, PH.D., P.A.
Entity Type:Organization
Organization Name:MARVIN H. BACKER, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-587-9558
Mailing Address - Street 1:222 E MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6240
Mailing Address - Country:US
Mailing Address - Phone:406-587-9558
Mailing Address - Fax:406-587-0534
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6240
Practice Address - Country:US
Practice Address - Phone:406-587-9558
Practice Address - Fax:406-587-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT80261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health