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NPI Code Detail

MEDICARE: MRS. JAMIE LYNN-MCBRIDE MAMMENGA LCPC

MEDICARE:  MRS. JAMIE LYNN-MCBRIDE MAMMENGA  LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor60985147WA
2101YM0800XMental Health CounselorBBH-LCPC-LIC-64820MT

General Provider Information

NPI Number : 1558605113
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE LYNN-MCBRIDE MAMMENGA LCPC
Provider Business Mailing Address
First Line : 944 AVENUE B
Second Line :
City : BILLINGS
State : MT
Zip : 59102-3346
Country : US
Telephone Number : 406-696-5258
Fax Number : 855-632-2807
Provider Business Practice Location Address
First Line : 944 AVENUE B
Second Line :
City : BILLINGS
State : MT
Zip : 59102-3346
Country : US
Telephone Number : 406-696-5258
Fax Number : 855-632-2807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 08/12/2024

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