Provider Demographics
NPI:1447655519
Name:MANGAN, PEGGY (MS REHABILITATION CO)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MANGAN
Suffix:
Gender:F
Credentials:MS REHABILITATION CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-0092
Mailing Address - Country:US
Mailing Address - Phone:406-479-0025
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2200
Practice Address - Country:US
Practice Address - Phone:406-479-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MT72506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health