Healthcare Provider Details

I. General information

NPI: 1649041955
Provider Name (Legal Business Name): JUSTIN YAVORSKI LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 S 22ND AVE STE 1A
BOZEMAN MT
59718-7054
US

IV. Provider business mailing address

1800 S. 22ND AVE. STE 120 #175
BOZEMAN MT
59718-5837
US

V. Phone/Fax

Practice location:
  • Phone: 406-312-9951
  • Fax:
Mailing address:
  • Phone: 406-312-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64867
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64867
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: