Provider Demographics
NPI:1134348642
Name:BARRETT, MARY JO (MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HIGGINS AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4462
Mailing Address - Country:US
Mailing Address - Phone:406-829-1300
Mailing Address - Fax:406-829-1400
Practice Address - Street 1:210 N HIGGINS AVE
Practice Address - Street 2:SUITE 338
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4462
Practice Address - Country:US
Practice Address - Phone:406-829-1300
Practice Address - Fax:406-829-1400
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000050182OtherMEDICARE PTAN
MT501993Medicaid
MT71423OtherBLUE CROSS BLUE SHIELD
MT000050182Medicare ID - Type UnspecifiedPROVIDER NUMBER