Provider Demographics
NPI:1407032238
Name:HAVARD, JIM (LAC)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:HAVARD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-5587
Mailing Address - Country:US
Mailing Address - Phone:406-222-2812
Mailing Address - Fax:406-222-4764
Practice Address - Street 1:430 E PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2755
Practice Address - Country:US
Practice Address - Phone:406-222-2812
Practice Address - Fax:406-222-4764
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)