Provider Demographics
NPI:1356552160
Name:DEBERRY, MARY JANE (LAC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-4258
Mailing Address - Country:US
Mailing Address - Phone:406-262-0626
Mailing Address - Fax:888-612-0942
Practice Address - Street 1:1105 CENTER DR
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-4258
Practice Address - Country:US
Practice Address - Phone:406-262-0626
Practice Address - Fax:888-612-0942
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1191LAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)