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Marty Scott Provost
Peer Specialist in Lakeview, Oregon
NPI 1639891914

Marty Scott Provost is a Peer Specialist based in Lakeview, OR. Marty Scott Provost practices in Lakeview, OR. The NPI Number for Marty Scott Provost is 1639891914 and holds a License No. (Oregon).

The current practice location address for Marty Scott Provost is 700 S J St, Lakeview, OR and can be reached out via phone at 541-947-6021.

Location: 700 S J St, Lakeview, OR, 97630-1623
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1639891914
Provider Name
Marty Scott Provost
Credential
Provider Entity Type
Individual
Gender
Male
Address
700 S J St, Lakeview, OR, 97630-1623
Phone Number
541-947-6021
Fax Number
Provider Enumeration Date
09/14/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
700 S J St
City
Lakeview
State
Oregon
Zip
97630-1623
Phone Number
541-947-6021
Fax Number
person
Provider Business Mailing Address Details
Address
700 S J St
City
Lakeview
State
Oregon
Zip
97630-1623
Phone Number
541-947-6021
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
(Oregon)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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