Organization
MAVIS VAILLANCOURT LCSW LAC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAVIS VAILLANCOURT LCSW LAC (OWNER)
(406) 546-8507
Entity
Organization
Contact information
Practice address
415 LOUISIANA AVE, LIBBY, MT 59923-2131
(406) 546-8507
Mailing address
415 LOUISIANA AVE, LIBBY, MT 59923-2131
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/08/2016
Last updated
03/12/2025
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