Healthcare Provider Details

I. General information

NPI: 1649611351
Provider Name (Legal Business Name): BROOKE JADE LEJEUNE LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE JADE SELLE LCAC

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 7TH ST W FL 4
DICKINSON ND
58601-4335
US

IV. Provider business mailing address

101 E BROADWAY AVE.
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-0386
  • Fax: 701-258-3602
Mailing address:
  • Phone: 701-222-0386
  • Fax: 701-255-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1712
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: