Provider Demographics
NPI:1245379338
Name:RYLEY, MARILYN MARJORIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MARJORIE
Last Name:RYLEY
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 1:2149 DURSTON RD STE 31
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2805
Mailing Address - Country:US
Mailing Address - Phone:406-580-7135
Mailing Address - Fax:
Practice Address - Street 1:2149 DURSTON RD STE 31
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2805
Practice Address - Country:US
Practice Address - Phone:406-580-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255294Medicaid
MT07487-6OtherBLUE CROSS PROVIDER NO.