Provider Demographics
NPI:1407437122
Name:MARTIN, JILLIAN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:
Last Name:MARTIN
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 1:321 E MAIN ST STE 319
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4721
Mailing Address - Country:US
Mailing Address - Phone:406-359-6352
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST STE 319
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4721
Practice Address - Country:US
Practice Address - Phone:406-359-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61437708101Y00000X
WAMC61189885101YM0800X
MTBBH-LCPC-LIC-62685101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health