Organization
MY HEALTHY LIFE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOWELL OWEN WAVRICK LAC (OWNER/EMPLOYEE)
(406) 945-1730
Entity
Organization
Contact information
Practice address
738 KENSINGTON AVE, MISSOULA, MT 59801-5720
(406) 945-1730
Mailing address
4998 SONOMA ST, MISSOULA, MT 59808-8694
(406) 945-1730
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/15/2020
Last updated
12/29/2020
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