Doctor Name: | JESSIE L ALLICK |
NPI Number: | 1063602266 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 1124 |
Business Practice Address: | 1601 Tammany St Anaconda, MT - 597111845 |
Business Phone Number: | 4065637365 |
Business Fax Number: | 4064941724 |
Mailing Address: | Po Box 1017, ANACONDA |
State: | MT |
Postal Code: | 597111017 |
Phone Number: | 4064966314 |
Fax Number: | 4064741724 |
NPI Enumeration Date: | 07/25/2007 |
NPI Last Update Date: | 07/25/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |