Provider Demographics
NPI:1871566513
Name:MEIS, MARY LOUISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:MEIS
Suffix:
Gender:F
Credentials:LCSW
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 573
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-0573
Mailing Address - Country:US
Mailing Address - Phone:406-434-5276
Mailing Address - Fax:406-424-2714
Practice Address - Street 1:236 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1910
Practice Address - Country:US
Practice Address - Phone:406-434-5276
Practice Address - Fax:406-424-2714
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000500055Medicaid
MT800004269OtherRAILROAD MEDICARE
MT0000502996Medicaid
MT0000503048Medicaid
MT71180OtherBC/BS
MTLCSW#196OtherSOCIAL WORK LICENSE
MT0000503113Medicaid
MT0000503048Medicaid