Provider Demographics
NPI:1497949473
Name:MAVOR, SUSAN PENDLETON (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PENDLETON
Last Name:MAVOR
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:MS
Other - First Name:SUNNY
Other - Middle Name:PENDLETON
Other - Last Name:MAVOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:SUITE 402-B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6241
Mailing Address - Country:US
Mailing Address - Phone:406-581-4011
Mailing Address - Fax:406-586-2835
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:SUITE 402-B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6241
Practice Address - Country:US
Practice Address - Phone:406-581-4011
Practice Address - Fax:406-586-2835
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health