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General NPI Number Information
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NPI Number | 1376265744
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Entity Type | Individual
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Provider Name | JESSICA CONNER NCC, PCLC, MA
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 700 SOUTH AVE W STE E
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City | MISSOULA
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State | MT
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Zip | 59801-8011
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Country | US
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Telephone | 406-624-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 423 W CENTRAL AVE
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City | MISSOULA
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State | MT
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Zip | 59801-6813
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Country | US
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Telephone | 808-387-1681
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 224241
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-PCLC-LIC-55023
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License Number State | MT
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