Provider Demographics
NPI:1881680783
Name:GRUMMETT, MARION (LCPC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:GRUMMETT
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 238
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0238
Mailing Address - Country:US
Mailing Address - Phone:406-322-4514
Mailing Address - Fax:406-322-4515
Practice Address - Street 1:410 EAST PIKE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019
Practice Address - Country:US
Practice Address - Phone:406-322-4514
Practice Address - Fax:406-322-4515
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT739LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT75208OtherBLUE CROSS BLUE SHIELD
MT75198OtherBLUE CROSS BLUE SHIELD