Individual
TARA IVANOVITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
2112 DIXON AVE STE 4, MISSOULA, MT 59801-8226
(406) 880-3123
(844) 500-6858
Mailing address
PO BOX 17962, MISSOULA, MT 59808-7962
(406) 880-3123
(844) 500-6858
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
42
MT
1041C0700X
Clinical Social Worker
Primary
25403
MT
Other
Enumeration date
01/19/2016
Last updated
05/03/2024
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