Provider Demographics
NPI:1629091152
Name:WOLDSTAD, MARY BARRON (MA, LCPC, CM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BARRON
Last Name:WOLDSTAD
Suffix:
Gender:F
Credentials:MA, LCPC, CM
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BARRON
Other - Last Name:STURHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC, CM
Mailing Address - Street 1:P.O. BOX 21
Mailing Address - Street 2:
Mailing Address - City:VALIER
Mailing Address - State:MT
Mailing Address - Zip Code:59486-0021
Mailing Address - Country:US
Mailing Address - Phone:406-338-3671
Mailing Address - Fax:406-338-3671
Practice Address - Street 1:422 MONTANA
Practice Address - Street 2:
Practice Address - City:VALIER
Practice Address - State:MT
Practice Address - Zip Code:59486
Practice Address - Country:US
Practice Address - Phone:406-338-3671
Practice Address - Fax:406-338-3671
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1156 LCPC101YP2500X
MT1156-LCPC101YP2500X
TX17659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000742990OtherBLUE CROSS/SHIELD OF MONT