Individual
LANDON RAY HEAVYRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
1511 S RUSSELL ST, MISSOULA, MT 59801-3629
(406) 829-9515
Mailing address
1309 S 2ND ST W APT 3, MISSOULA, MT 59801-2386
(406) 529-0913
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-72934
MT
Other
Enumeration date
10/25/2024
Last updated
10/25/2024
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