Provider Demographics
NPI:1023119450
Name:CATHERINE ANNE MACLEAN PHD PC
Entity type:Organization
Organization Name:CATHERINE ANNE MACLEAN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MACLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-585-9890
Mailing Address - Street 1:PO BOX 6576
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771
Mailing Address - Country:US
Mailing Address - Phone:406-585-9890
Mailing Address - Fax:406-582-1116
Practice Address - Street 1:3825 VALLEY COMMONS DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-585-9890
Practice Address - Fax:406-556-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT180103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52640OtherBLUE CROSS BLUE SHIELD
MT0491881Medicaid
5253Medicare ID - Type Unspecified