Provider Demographics
NPI:1437265170
Name:BEATTY, JENNIFER F (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:BEATTY
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 1:108 N FRONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2200
Mailing Address - Country:US
Mailing Address - Phone:406-980-0672
Mailing Address - Fax:888-972-9114
Practice Address - Street 1:108 N FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2200
Practice Address - Country:US
Practice Address - Phone:406-980-0672
Practice Address - Fax:888-972-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1117101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256241Medicaid