Individual
MARILYN FENTON MONTVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
721 SHERIDAN AVE, SUITE 260, CODY, WY 82414-3423
(307) 527-5312
(307) 578-2212
Mailing address
1514 SHEPARD PL, CODY, WY 82414-4220
(307) 587-9596
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
237
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11661674
CAQH UNIVERSAL CREDENTIAL
WY
Enumeration date
01/16/2007
Last updated
07/08/2007
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