Ivon L Waters, PCLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

BBH-PCLC-LIC-44130 Issued in MT

Practice address

81 Treasure State Dr
Great Falls, MT 59404-3454

Phone

(406) 402-6400

NPI assigned

Jun 23, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ivan L Wodarz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dynamic RecoveryGroup PAC ID 2365883733, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Great Falls, MT
  • NPI 1427767037
  Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1285310482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 TREASURE STATE DR",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594043454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 TREASURE STATE DR",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594043454",
            "telephone_number": "406-402-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "IVON",
        "middle_name": "L",
        "credential": "PCLC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MT",
            "license": "BBH-PCLC-LIC-44130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVAN",
            "last_name": "WODARZ",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Warma, M.A.CCC -SLP
• Cristal Warneke, P.T.A.
• Kathryn Warner, PH.D, LCPC, LPC, NCC
• Stephen Harold Warner, LCPC
• Thomas A Warr, MD
• Rita J Watson, LCSW
• Tammy Lee Watson
• Jeremiah Watt, FNP
• Michael Webster, MD
• Curtis Andrew Weems

• Professional Counselor in Great Falls, MT
• Providers in Great Falls, MT by specialty
• Professional Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.