Organization
HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BAIN (CO-EXECUTIVE DIRECTOR)
(406) 586-7689
Entity
Organization
Contact information
Practice address
1996 LITTLE COTTAGE LN APT 9, BOZEMAN, MT 59715-9440
(406) 586-7689
Mailing address
PO BOX 752, BOZEMAN, MT 59771-0752
(406) 586-7689
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC4673
MT
Other
Enumeration date
01/26/2016
Last updated
01/26/2016
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