Provider Demographics
NPI:1922000538
Name:NORTH, MARLA JEAN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:JEAN
Last Name:NORTH
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 1:505 W MAIN ST
Mailing Address - Street 2:STE 218
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-5703
Mailing Address - Country:US
Mailing Address - Phone:406-538-5990
Mailing Address - Fax:406-538-4564
Practice Address - Street 1:505 W MAIN ST
Practice Address - Street 2:STE 218
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-5703
Practice Address - Country:US
Practice Address - Phone:406-538-5990
Practice Address - Fax:406-538-4564
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT401-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
75241OtherBLUECROSS BLUESHIELD
MT0252252Medicaid
N8215OtherAPS HEALTHCARE
218070OtherCOMPSYCH
114332OtherMAGELLAN HEALTH SERVICES