Healthcare Provider Details

I. General information

NPI: 1093544041
Provider Name (Legal Business Name): JENNA NEVE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 HUGH LILLARD LN
HERON MT
59844-9583
US

IV. Provider business mailing address

PO BOX 321
HERON MT
59844-0321
US

V. Phone/Fax

Practice location:
  • Phone: 802-345-0585
  • Fax:
Mailing address:
  • Phone: 802-345-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70218
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10428
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: