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General NPI Number Information
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NPI Number | 1194228023
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Entity Type | Individual
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Provider Name | JENEANE C NICODEMUS LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 518 TAMARACK CREEK RD
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City | WHITEFISH
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State | MT
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Zip | 59937
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Country | US
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Telephone | 805-635-7108
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Fax |
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Provider Business Mailing Address
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Address Line | 424 BAKER AVE UNIT 4687
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City | WHITEFISH
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State | MT
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Zip | 59937-7114
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Country | US
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Telephone | 805-635-7108
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 128506
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License Number State | CA
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