Provider Demographics
NPI:1730585316
Name:PARRISH, STEPHEN RANDALL (DMFT, LCPC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RANDALL
Last Name:PARRISH
Suffix:
Gender:M
Credentials:DMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 2ND AVE N
Mailing Address - Street 2:OLIVE BRANCH PSYCHOTHERAPY
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3259
Mailing Address - Country:US
Mailing Address - Phone:406-217-2338
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:OLIVE BRANCH PSYCHOTHERAPY
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-217-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0750390OtherBLUE CROSS-SHIELD OF MONTANA