Healthcare Provider Details

I. General information

NPI: 1184534984
Provider Name (Legal Business Name): NICHOLAS DANIEL JACQUOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 N 29TH ST
BILLINGS MT
59101-0122
US

IV. Provider business mailing address

1245 N 29TH ST
BILLINGS MT
59101-0122
US

V. Phone/Fax

Practice location:
  • Phone: 406-252-5658
  • Fax: 406-238-3679
Mailing address:
  • Phone: 406-252-5658
  • Fax: 406-238-3679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-90576
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: