Provider Demographics
NPI:1902541576
Name:WEST, IVA M (ACLC)
Entity type:Individual
Prefix:MRS
First Name:IVA
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:IVA
Other - Middle Name:
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 5771
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-5771
Mailing Address - Country:US
Mailing Address - Phone:406-422-4933
Mailing Address - Fax:
Practice Address - Street 1:833 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3352
Practice Address - Country:US
Practice Address - Phone:406-422-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-55556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT55556OtherSTATE LICENSE