Marty Scott Provost
Marty Scott Provost is a Peer Specialist in Lakeview, Oregon. Licensed in Oregon. Registered with an NPI since 2022.
- Licensed in
- OR
- In the registry since
- 2022
Practice location Address checks out
700 S J StLakeview, OR 97630-1623
Phone: (541) 947-6021
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Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X (OR) |
|---|
Record details
| NPI number | 1639891914 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | September 14, 2022 |
| Last updated in NPPES | September 14, 2022 |
| Certification date | September 14, 2022 |
| Mailing address | 700 S J St, Lakeview, OR 97630-1623 |
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Nicole Alicia Forbes
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