Provider Demographics
NPI:1164857975
Name:JENSEN, NICOLE (LCPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:KELTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 21352
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1352
Mailing Address - Country:US
Mailing Address - Phone:406-697-6406
Mailing Address - Fax:406-254-1674
Practice Address - Street 1:3021 6TH AVE N
Practice Address - Street 2:STE 110
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1145
Practice Address - Country:US
Practice Address - Phone:406-697-6406
Practice Address - Fax:406-254-1674
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health