Provider Demographics
NPI:1659458818
Name:LIVOTI, LETA A (LCSW LCPC)
Entity Type:Individual
Prefix:DR
First Name:LETA
Middle Name:A
Last Name:LIVOTI
Suffix:
Gender:F
Credentials:LCSW LCPC
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 2209
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873
Mailing Address - Country:US
Mailing Address - Phone:406-827-0700
Mailing Address - Fax:
Practice Address - Street 1:115 BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:406-827-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT233LCPC101YP2500X
MT232LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT501566Medicaid
MT9410OtherBLUE CROSS