Healthcare Provider Details

I. General information

NPI: 1730900549
Provider Name (Legal Business Name): JAYNA RACE, LMHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S WOODARD AVE
ABSAROKEE MT
59001-6326
US

IV. Provider business mailing address

PO BOX 656
ABSAROKEE MT
59001-0656
US

V. Phone/Fax

Practice location:
  • Phone: 407-558-0093
  • Fax:
Mailing address:
  • Phone: 407-558-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAYNA RACE
Title or Position: LICENSED CLINICAL PROFESSIONAL
Credential: LCPC
Phone: 407-558-0093