Healthcare Provider Details

I. General information

NPI: 1861161788
Provider Name (Legal Business Name): MATTHEW BRYAN LUVISI MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S FERGUSON AVE STE 6
BOZEMAN MT
59718-6483
US

IV. Provider business mailing address

PO BOX 6154
BOZEMAN MT
59771-6154
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-6291
  • Fax: 406-551-4624
Mailing address:
  • Phone: 406-404-6291
  • Fax: 406-551-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number50482
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: