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General NPI Number Information
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NPI Number | 1285310482
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Entity Type | Individual
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Provider Name | IVON L WATERS PCLC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 81 TREASURE STATE DR
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City | GREAT FALLS
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State | MT
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Zip | 59404-3454
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Country | US
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Telephone | 406-402-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 81 TREASURE STATE DR
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City | GREAT FALLS
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State | MT
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Zip | 59404-3454
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-PCLC-LIC-44130
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License Number State | MT
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