Provider Demographics
NPI:1013423573
Name:HAVNER, AMIE LAURAYNE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:LAURAYNE
Last Name:HAVNER
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE ELMO DR STE 6
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1798
Mailing Address - Country:US
Mailing Address - Phone:406-969-5183
Mailing Address - Fax:
Practice Address - Street 1:1411 MAIN ST STE B-C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1712
Practice Address - Country:US
Practice Address - Phone:406-969-5183
Practice Address - Fax:406-281-8308
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27101101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27101OtherLCPC