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1215638028
GAVIN JOSEPH WISDOM
MISSOULA, MT
NPI
1215638028
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT BBH-LAC-LIC-62611)
Enumeration Date
2023-03-17
Last Update Date
2023-03-17
Business Address
Mr. GAVIN JOSEPH WISDOM MSW, LAC, SWLC
2825 STOCKYARD RD STE A11
MISSOULA, MT 59808-1544
Phone number: 406-543-5531
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Mailing Address
Mr. GAVIN JOSEPH WISDOM MSW, LAC, SWLC
404 3RD AVE E
KALISPELL, MT 59901-4907
Phone number: 303-601-1536
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