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General NPI Number Information
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NPI Number | 1043613144
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Entity Type | Individual
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Provider Name | TODD HAVELKA LCSW, LAC
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Gender | Male
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 2419 MULLAN RD STE F
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City | MISSOULA
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State | MT
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Zip | 59808-1856
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Country | US
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Telephone | 406-880-4455
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Fax | 406-926-3808
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Provider Business Mailing Address
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Address Line | 2927 PRADA DR
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City | MISSOULA
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State | MT
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Zip | 59808-9612
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Country | US
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Telephone | 406-880-4455
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Fax | 406-926-3808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16657
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4172
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License Number State | MT
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