| Doctor Name: | MS. MAVIS H. VAILLANCOURT |
| NPI Number: | 1134139058 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW, LAC |
| License Number: | 1140 |
| Business Practice Address: | 320 E 2nd St Libby, MT - 599232010 |
| Business Phone Number: | 4062836900 |
| Business Fax Number: | |
| Mailing Address: | 320 E 2nd St, LIBBY |
| State: | MT |
| Postal Code: | 599232010 |
| Phone Number: | 4062836900 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2006 |
| NPI Last Update Date: | 08/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1140 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |