Provider Demographics
NPI:1861559957
Name:ZOOK, DONNA MAY (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MAY
Last Name:ZOOK
Suffix:
Gender:F
Credentials:PHD
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:SUITE 620
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3259
Mailing Address - Country:US
Mailing Address - Phone:406-453-5638
Mailing Address - Fax:406-453-1534
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:SUITE 620
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-453-5638
Practice Address - Fax:406-453-1534
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1054101YP2500X
MTMT349103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0491674Medicaid
MT740360OtherBCBS