Provider Demographics
NPI:1629295969
Name:IVERS, MARILYN J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:IVERS
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:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403
Mailing Address - Country:US
Mailing Address - Phone:406-453-3384
Mailing Address - Fax:
Practice Address - Street 1:410 CENTRAL AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-453-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT74915OtherBLUE CROSS BLUE SHIELD
MT254150Medicaid