Healthcare Provider Details

I. General information

NPI: 1124679196
Provider Name (Legal Business Name): JEANETTE ELAINE BILSTEIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANETTE ELAINE BILSTEIN

II. Dates (important events)

Enumeration Date: 09/21/2019
Last Update Date: 09/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MAIN ST
TORRINGTON WY
82240-3340
US

IV. Provider business mailing address

1609 22ND AVE
MITCHELL NE
69357-1218
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax:
Mailing address:
  • Phone: 402-480-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-1147
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: