Individual
MR. MARK ERIC ROTHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
336 W SPRUCE ST, MISSOULA, MT 59802-4108
(406) 529-1610
(406) 721-2860
Mailing address
102 NORTH AVE W, MISSOULA, MT 59801-6713
(406) 529-1610
(406) 721-2860
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1141-LCPC
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0257179
—
MT
01
—
743680
BLUE CROSS BLUE SHIELD
MT
Enumeration date
04/02/2007
Last updated
07/08/2007
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