Healthcare Provider Details

I. General information

NPI: 1942494109
Provider Name (Legal Business Name): JENI RUTH GOCHIN LMFT, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S WILLSON AVE
BOZEMAN MT
59715-6232
US

IV. Provider business mailing address

PO BOX 6774
BOZEMAN MT
59771-6774
US

V. Phone/Fax

Practice location:
  • Phone: 406-551-4535
  • Fax: 406-551-1207
Mailing address:
  • Phone: 406-551-4535
  • Fax: 406-551-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2414
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number75
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: