Healthcare Provider Details

I. General information

NPI: 1073359725
Provider Name (Legal Business Name): JENNIFER M KAMPS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1078
THREE FORKS MT
59752-1078
US

IV. Provider business mailing address

PO BOX 1078
THREE FORKS MT
59752-1078
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-3251
  • Fax:
Mailing address:
  • Phone: 406-285-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-71910
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: