Healthcare Provider Details

I. General information

NPI: 1588810923
Provider Name (Legal Business Name): JAMI RAYE EADS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMI RAYE BROGAN

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 MONTANA AVE
DEER LODGE MT
59722-1548
US

IV. Provider business mailing address

507 MONTANA AVE
DEER LODGE MT
59722-1548
US

V. Phone/Fax

Practice location:
  • Phone: 406-599-9600
  • Fax:
Mailing address:
  • Phone: 406-599-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1370-LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: