Provider Demographics
NPI:1063604585
Name:MANN, CALVIN GORDON (LCPC)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:GORDON
Last Name:MANN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MARY ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4144
Mailing Address - Country:US
Mailing Address - Phone:406-238-0424
Mailing Address - Fax:406-494-1724
Practice Address - Street 1:1006 MARY ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4144
Practice Address - Country:US
Practice Address - Phone:406-238-0424
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT764OtherSTATE OF MONTANA LICENSE