Provider Demographics
NPI:1730361213
Name:GOETZ, JENNIFER L (MS, LCPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:GOETZ
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:1724 LAMPMAN DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6494
Mailing Address - Country:US
Mailing Address - Phone:406-256-3224
Mailing Address - Fax:
Practice Address - Street 1:1724 LAMPMAN DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6494
Practice Address - Country:US
Practice Address - Phone:406-256-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1182101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor