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General NPI Number Information
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NPI Number | 1598358582
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Entity Type | Individual
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Provider Name | JACLYN RUBBO SATRE LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 114 W PINE ST STE 8
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City | MISSOULA
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State | MT
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Zip | 59802-4222
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Country | US
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Telephone | 406-540-0858
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9405
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City | MISSOULA
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State | MT
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Zip | 59807-9405
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Country | US
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Telephone | 406-540-0858
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 120456
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 45928
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License Number State | MT
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