Individual
MARISSA MAE ILAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
402 1ST ST. E. #205, POLSON, MT 59860
(406) 260-1716
Mailing address
PO BOX 731, HOT SPRINGS, MT 59845-0731
(406) 260-1716
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBH-LCPC-LIC-48659
MT
Other
Enumeration date
05/06/2021
Last updated
05/06/2021
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