Provider Demographics
NPI:1598865131
Name:MARSENICH, MILANA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:MILANA
Middle Name:MARIE
Last Name:MARSENICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 1ST ST W STE 203
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2602
Mailing Address - Country:US
Mailing Address - Phone:406-883-0026
Mailing Address - Fax:
Practice Address - Street 1:302 1ST ST W STE 203
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2602
Practice Address - Country:US
Practice Address - Phone:406-883-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0253357Medicaid
MT742830OtherBCBS PROVIDER NUMBER