Provider Demographics
NPI:1043556145
Name:HARVEY, CONNIE (SWP, LCSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:SWP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W MAIN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-5703
Mailing Address - Country:US
Mailing Address - Phone:406-535-5990
Mailing Address - Fax:406-535-4564
Practice Address - Street 1:505 W MAIN ST STE 225
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-5703
Practice Address - Country:US
Practice Address - Phone:406-535-5990
Practice Address - Fax:406-535-4564
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical