MEDICARE: AMIE LAURAYNE HAVNER MS, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	27101	MT
2	101YP2500X	Professional Counselor	27101	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27101	OTHER	MT	LCPC

General Provider Information

NPI Number	:	1013423573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIE LAURAYNE HAVNER MS, LCPC

Provider Business Mailing Address
First Line	:	1540 LAKE ELMO DR STE 6
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-1798
Country	:	US
Telephone Number	:	406-969-5183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 MAIN ST STE B-C
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-1712
Country	:	US
Telephone Number	:	406-969-5183
Fax Number	:	406-281-8308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	09/07/2020

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