Individual ProviderMartha Fairchild DudleyCounselorBehavioral Health & Social Service ProvidersPractice Address612 E Main St, Suite B, Bozeman, MT 59715-3719(406) 539-0300PECOS EnrollmentBased on the most recent information from CMS, provider Martha Fairchild Dudley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1366566358Provider TypeIndividualFull NameDudley, Martha FairchildCredentialLCPCGenderFemaleSole ProprietorYesEnumeration Date3/17/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address612 E Main St, Suite B, Bozeman, MT 59715-3719Phone(406) 539-0300Fax(406) 522-0286Mailing LocationMailing Address612 E Main St, Suite B, Bozeman, MT 59715-3719Phone(406) 539-0300Fax(406) 522-0286Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense1037MontanaProvider IdentifiersIDDescriptionIssuerID0255102DescriptionMedicaidIssuerUnlistedMontana