Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 936 | MT |
NPI | 1003152372 |
---|---|
Provider Name | Donna Jean Suden |
First Address | Glasgow, MT 59230-1697 |
Second Address | Glasgow, MT 59230-1697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2012 |
Last Update Date | 14/12/2012 |