MEDICARE: CODY HARVEY 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	101YP2500X	Professional Counselor	1545	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700184017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY HARVEY LCPC

Provider Business Mailing Address
First Line	:	PO BOX 3066
Second Line	:	KAIROS YOUTH SERVICES, INC.
City	:	GREAT FALLS
State	:	MT
Zip	:	59403-3066
Country	:	US
Telephone Number	:	406-727-0076
Fax Number	:	406-452-8382

Provider Business Practice Location Address
First Line	:	4513 7TH AVE N
Second Line	:	KAIROS YOUTH SERVICES
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-1124
Country	:	US
Telephone Number	:	406-727-0076
Fax Number	:	406-452-8382

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/06/2013

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