Provider Demographics
NPI:1700184017
Name:HARVEY, CODY (LCPC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials: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 3066
Mailing Address - Street 2:KAIROS YOUTH SERVICES, INC.
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3066
Mailing Address - Country:US
Mailing Address - Phone:406-727-0076
Mailing Address - Fax:406-452-8382
Practice Address - Street 1:4513 7TH AVE N
Practice Address - Street 2:KAIROS YOUTH SERVICES
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1124
Practice Address - Country:US
Practice Address - Phone:406-727-0076
Practice Address - Fax:406-452-8382
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT320359Medicaid