Marissa Mae Ilac, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

BBH-LCPC-LIC-48659 Issued in MT

Practice address

402 1St St. E. #205
Polson, MT 59860

Phone

(406) 260-1716

NPI assigned

May 6, 2021

Last updated

May 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Marissa Mae Ilac Professional name

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1497339493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731",
            "city": "HOT SPRINGS",
            "state": "MT",
            "postal_code": "598450731",
            "telephone_number": "406-260-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 1ST ST. E. #205",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-260-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILAC",
        "first_name": "MARISSA",
        "middle_name": "MAE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-06",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MT",
            "license": "BBH-LCPC-LIC-48659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "ILAC",
            "middle_name": "MAE",
            "credential": "LCPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ashlee Olivia Howell, DPT
• Heather Michelle Howell
• Clint Hoxie, O.D.
• Amber Ann Hughes, LCSW
• Macy Ray Hyvonen, DMD
• R Stephen Irwin, M. D.
• Jeffrey D. Heninger, O.D. PLLC (Polson Family Eyecare)
• Kelly D Jenne, NP
• Kristi Ann Joachim
• Amy M. Johnson, FNP

• Mental Health Counselor in Polson, MT
• Providers in Polson, MT by specialty
• Mental Health Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.