Provider Demographics
NPI:1184217952
Name:KOFFLER, JESSICA D (LCPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:KOFFLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 6TH ST NW STE 9
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-2449
Mailing Address - Country:US
Mailing Address - Phone:406-771-8182
Mailing Address - Fax:
Practice Address - Street 1:600 6TH ST NW STE 9
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-2449
Practice Address - Country:US
Practice Address - Phone:406-771-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-45311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health