Provider Demographics
NPI:1750730974
Name:CHARVAT, MICHAEL LYNN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LYNN
Last Name:CHARVAT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICK
Other - Middle Name:LYNN
Other - Last Name:CHARVAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:821 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-259-9695
Mailing Address - Fax:406-259-0764
Practice Address - Street 1:3109 1ST AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2102
Practice Address - Country:US
Practice Address - Phone:406-259-9695
Practice Address - Fax:406-259-0764
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT675101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor