Provider Demographics
NPI:1902394927
Name:MCMANIS, MARIAH RENE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:RENE
Last Name:MCMANIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:RENE
Other - Last Name:MCMANIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2504 W MAIN ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4073
Mailing Address - Country:US
Mailing Address - Phone:406-595-3822
Mailing Address - Fax:
Practice Address - Street 1:2504 W MAIN ST STE 2F
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3966
Practice Address - Country:US
Practice Address - Phone:406-595-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT241061041C0700X
1041C0700X
BBH-SWLC-LIC-241061041C0700X
MTBBH-LCSW-LIC-642841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical