Provider Demographics
NPI:1538183629
Name:WHITFIELD, JENNIFER TAYLOR (LCPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TAYLOR
Last Name:WHITFIELD
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 1:3601 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3431
Mailing Address - Country:US
Mailing Address - Phone:406-453-3154
Mailing Address - Fax:
Practice Address - Street 1:2601 8TH ST NE
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/NORTH MIDDLE SCHOOL
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1604
Practice Address - Country:US
Practice Address - Phone:406-268-6571
Practice Address - Fax:406-761-0554
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1179 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000743030OtherBLUE CROSS/SHIELD OF MONT