Provider Demographics
NPI:1093006710
Name:WESTERHOLD, JESSICA (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WESTERHOLD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3724 E RIGGS ST
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3377
Mailing Address - Country:US
Mailing Address - Phone:406-208-5448
Mailing Address - Fax:
Practice Address - Street 1:60 S. LAST CHANCE GULCH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-447-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)