Provider Demographics
NPI:1013300540
Name:LAVALLIE, GENEVA (LSW)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:LAVALLIE
Suffix:
Gender:F
Credentials:LSW
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 1970
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1970
Mailing Address - Country:US
Mailing Address - Phone:701-477-0525
Mailing Address - Fax:
Practice Address - Street 1:1820 WALNUT ST E STE 5
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3411
Practice Address - Country:US
Practice Address - Phone:701-662-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4412104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker