Healthcare Provider Details

I. General information

NPI: 1972690147
Provider Name (Legal Business Name): JUANITA NANCY TRIPLETT MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NOXON AVE
NOXON MT
59853-9762
US

IV. Provider business mailing address

PO BOX 1234
THOMPSON FALLS MT
59873-1234
US

V. Phone/Fax

Practice location:
  • Phone: 406-827-3357
  • Fax:
Mailing address:
  • Phone: 406-827-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number108
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: