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General NPI Number Information
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NPI Number | 1497395255
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Entity Type | Individual
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Provider Name | JESSICA MIRANDA ROSE WEISZ LCPC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 108 29TH AVE NE
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City | GREAT FALLS
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State | MT
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Zip | 59404-1002
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Country | US
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Telephone | 805-302-4323
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Fax |
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Provider Business Mailing Address
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Address Line | 108 29TH AVE NE
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City | GREAT FALLS
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State | MT
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Zip | 59404-1002
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Country | US
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Telephone | 805-302-4323
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCPC-LIC-38202
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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 | LPCC10515
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License Number State | CA
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