Healthcare Provider Details

I. General information

NPI: 1265407621
Provider Name (Legal Business Name): JAMEY LYNN IVEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMEY LYNN DOMBROSKI LCPC

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 1ST AVE S CENTER FOR MENTAL HEALTH
GREAT FALLS MT
59401-3705
US

IV. Provider business mailing address

PO BOX 32
FORT SHAW MT
59443-0032
US

V. Phone/Fax

Practice location:
  • Phone: 406-791-9533
  • Fax: 406-761-2107
Mailing address:
  • Phone: 406-264-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1194 LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: