Provider Demographics
NPI:1568558591
Name:HESS-HOMEIER, MARY JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOAN
Last Name:HESS-HOMEIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S. FIFTH ST., W.
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2619
Mailing Address - Country:US
Mailing Address - Phone:406-543-6736
Mailing Address - Fax:
Practice Address - Street 1:445 S. FIFTH ST., W.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2619
Practice Address - Country:US
Practice Address - Phone:406-543-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5181-0OtherMJHH, INC BLUE CROSS/BL
MT49-0776Medicaid
MT49-0776Medicaid