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General NPI Number Information
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NPI Number | 1194204412
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Entity Type | Individual
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Provider Name | JAKE GIFFUNI
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 127 N HIGGINS AVE STE 307E
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City | MISSOULA
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State | MT
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Zip | 59802-4486
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Country | US
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Telephone | 631-291-3294
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Fax |
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Provider Business Mailing Address
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Address Line | 1513 NORTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-5503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10269706-6006
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-LAC-LIC-55608
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License Number State | MT
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