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General NPI Number Information
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NPI Number | 1457884587
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Entity Type | Individual
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Provider Name | KADE JESSE ANDERSON MA, LCPC
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Gender | Male
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 1305 WYOMING ST
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City | MISSOULA
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State | MT
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Zip | 59801-1725
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Country | US
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Telephone | 406-532-9700
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Fax | 406-541-3035
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Provider Business Mailing Address
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Address Line | 1305 WYOMING ST
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City | MISSOULA
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State | MT
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Zip | 59801-1725
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Country | US
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Telephone | 406-532-9700
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Fax | 406-541-3035
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 23244
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License Number State | MT
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