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General NPI Number Information
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NPI Number | 1902615313
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Entity Type | Individual
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Provider Name | ELIJAHBEN JASSO PCLC, NCC
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Gender | Male
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 1250 15TH ST W
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City | BILLINGS
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State | MT
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Zip | 59102-4155
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Country | US
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Telephone | 406-247-4966
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Fax |
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Provider Business Mailing Address
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Address Line | 52 E 5TH ST
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City | LOVELL
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State | WY
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Zip | 82431-1902
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Country | US
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Telephone | 307-272-7042
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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-PCLC-LIC-55503
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License Number State | MT
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