| Mavis Vaillancourt Lcsw Lac Llc | |
|
415 Louisiana Ave Libby MT 59923-2131 | |
| (406) 546-8507 | |
| Not Available |
| Full Name | Mavis Vaillancourt Lcsw Lac Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 415 Louisiana Ave, Libby, Montana |
| Authorized Official Name and Position | Mavis Vaillancourt (OWNER) |
| Authorized Official Contact | 4065468507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mavis Vaillancourt Lcsw Lac Llc 415 Louisiana Ave Libby MT 59923-2131 Ph: () - | Mavis Vaillancourt Lcsw Lac Llc 415 Louisiana Ave Libby MT 59923-2131 Ph: (406) 546-8507 |
| NPI Number | 1699229682 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 08/08/2016 |
| Medicare PECOS PAC ID | 2062708837 |
|---|---|
| Medicare Enrollment ID | O20160902000056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699229682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mavis H Vaillancourt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134139058 PECOS PAC ID: 2466592886 Enrollment ID: I20091216000215 |
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