Individual
ANDREW C HEAVYRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1511 S RUSSELL ST, MISSOULA, MT 59801-3629
(406) 829-9515
Mailing address
2100 STEPHENS AVE STE 105, MISSOULA, MT 59801-6607
(406) 829-9515
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
58896
MT
Other
Enumeration date
10/24/2022
Last updated
11/21/2022
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