Provider Demographics
NPI:1790541688
Name:GOSVENER, OLIVIA MORICCA (LCSW - CANDIDATE)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MORICCA
Last Name:GOSVENER
Suffix:
Gender:F
Credentials:LCSW - CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 JEANNETTE RANKIN DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5817
Mailing Address - Country:US
Mailing Address - Phone:559-593-3223
Mailing Address - Fax:
Practice Address - Street 1:1211 ECHELON PL STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7693
Practice Address - Country:US
Practice Address - Phone:559-593-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SLC-LIC-702811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical