Provider Demographics
NPI:1376265744
Name:CONNER, JESSICA (NCC, PCLC, MA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:NCC, PCLC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6813
Mailing Address - Country:US
Mailing Address - Phone:808-387-1681
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTH AVE W STE E
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8011
Practice Address - Country:US
Practice Address - Phone:406-624-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT224241101YS0200X
MTBBH-PCLC-LIC-55023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool