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1861707622
LOUELLA KELLY HEAVY RUNNER
MISSOULA, MT
NPI
1861707622
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT 1063)
Enumeration Date
2010-08-17
Last Update Date
2010-08-17
Business Address
Ms. LOUELLA KELLY HEAVY RUNNER LAC
1325 WYOMING ST
MISSOULA, MT 59801-1725
Phone number: 406-532-9800
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Mailing Address
Ms. LOUELLA KELLY HEAVY RUNNER LAC
T-9 FORT MISSOULA
MISSOULA, MT 59804-7202
Phone number: 406-532-8400
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