Marty Scott Provost

NPI #1639891914 in Lakeview, Oregon

Provider Information

NPI Number: 1639891914
Entity Type: Individual
Name: Marty Scott Provost
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Sep 14, 2022
Last Updated: Sep 14, 2022

Practice Location

Address: 700 S J ST
City: Lakeview
State: Oregon
ZIP Code: 97630-1623
Phone: (541) 947-6021

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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