MEDICARE: JESSE KING LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	BBH-LMFT-LIC-48899	MT

General Provider Information

NPI Number	:	1891377719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE KING LMFT

Provider Business Mailing Address
First Line	:	1001 SW HIGGINS AVE STE 201
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1340
Country	:	US
Telephone Number	:	808-347-2098
Fax Number	:	406-858-9002

Provider Business Practice Location Address
First Line	:	1135 STRAND AVE STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5678
Country	:	US
Telephone Number	:	406-828-1582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	02/12/2023

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