Healthcare Provider Details

I. General information

NPI: 1407783129
Provider Name (Legal Business Name): JENSA RAE DAVIDSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENSA RAE BAUMGARTNER LAC

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 1ST AVE N
GREAT FALLS MT
59401-2510
US

IV. Provider business mailing address

1801 13TH AVE S
GREAT FALLS MT
59405-4808
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6973
  • Fax:
Mailing address:
  • Phone: 406-799-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-78709
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: