Provider Demographics
NPI:1538934278
Name:LIVDAHL, MARA (LCPC)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:LIVDAHL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W KENT AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6619
Mailing Address - Country:US
Mailing Address - Phone:406-720-5236
Mailing Address - Fax:406-341-2326
Practice Address - Street 1:825 W KENT AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6619
Practice Address - Country:US
Practice Address - Phone:406-720-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT79078101YP2500X
MT63259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health