Individual
MRS. PETREA MARY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
400 4TH AVENUE WEST, POPLAR, MT 59255
(406) 768-6763
(406) 768-6802
Mailing address
14419 COUNTY ROAD 323, BROCKTON, MT 59213-9510
(406) 787-5500
(406) 787-5500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1159-LCPC
MT
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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