Healthcare Provider Details

I. General information

NPI: 1467174623
Provider Name (Legal Business Name): JESSICA BROOKE WOHLERS MS, PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W KAGY BLVD STE N
BOZEMAN MT
59715-6043
US

IV. Provider business mailing address

115 W KAGY BLVD
BOZEMAN MT
59715-6027
US

V. Phone/Fax

Practice location:
  • Phone: 406-812-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number57372
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: