Healthcare Provider Details

I. General information

NPI: 1659675197
Provider Name (Legal Business Name): JESSE MILLER MUMFORD HEIDE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSE MILLER MUMFORD LCSW

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N PARK AVE
HELENA MT
59601-2703
US

IV. Provider business mailing address

PO BOX 518
HELENA MT
59624-0518
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-8774
  • Fax: 406-442-0428
Mailing address:
  • Phone: 406-442-8774
  • Fax: 406-442-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-87769
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number978
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: