Provider Demographics
NPI:1205857414
Name:DUSSAULT, JEANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:DUSSAULT
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 1:800 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4002
Mailing Address - Country:US
Mailing Address - Phone:406-453-5434
Mailing Address - Fax:406-452-9040
Practice Address - Street 1:800 2ND ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4002
Practice Address - Country:US
Practice Address - Phone:406-453-5434
Practice Address - Fax:406-452-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256503Medicaid
MT741830OtherBLUECROSS BLUESHIELD