Provider Demographics
NPI:1952391930
Name:CALOVIS, KATHERINE G (LAC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
Last Name:CALOVIS
Suffix:
Gender:F
Credentials:LAC
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 44
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-0044
Mailing Address - Country:US
Mailing Address - Phone:406-538-7483
Mailing Address - Fax:406-538-7491
Practice Address - Street 1:212 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2297
Practice Address - Country:US
Practice Address - Phone:406-538-7483
Practice Address - Fax:406-538-7491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)