Provider Demographics
NPI:1437364585
Name:TAINTER, JENNIFER ADELLA (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ADELLA
Last Name:TAINTER
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 1:2023 STADIUM DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0613
Mailing Address - Country:US
Mailing Address - Phone:406-579-3790
Mailing Address - Fax:406-219-3428
Practice Address - Street 1:2023 STADIUM DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-0613
Practice Address - Country:US
Practice Address - Phone:406-579-3790
Practice Address - Fax:406-219-3428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256685Medicaid
MT742200OtherBCBS