Provider Demographics
NPI:1841219060
Name:MOWERY, MARLENE JEANETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:JEANETTE
Last Name:MOWERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 2ND AVENUE NORTH SUITE 338
Mailing Address - Street 2:COLUMBUS CENTER
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401
Mailing Address - Country:US
Mailing Address - Phone:406-750-9959
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVENUE NORTH SUITE 338
Practice Address - Street 2:COLUMBUS CENTER
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-750-9959
Practice Address - Fax:406-761-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT322103TC0700X
MT#322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000051741OtherBLUE CROSS/SHIELD OF MT
MT680015337OtherRAILROAD MEDICARE
MT680015337OtherRAILROAD MEDICARE