Provider Demographics
NPI:1306833165
Name:PHILLIPS, JEANNETTE E (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:E
Last Name:PHILLIPS
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 1:3147 MARGUERITE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0426
Mailing Address - Country:US
Mailing Address - Phone:406-656-0579
Mailing Address - Fax:
Practice Address - Street 1:3147 MARGUERITE BLVD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0426
Practice Address - Country:US
Practice Address - Phone:406-656-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1029LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health