Provider Demographics
NPI:1497106926
Name:GRUBER, JESSICA (LCPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BERTOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-443-7151
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:900 JACKSON ST
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3428
Practice Address - Country:US
Practice Address - Phone:406-443-7151
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0753400OtherBLUE CROSS-SHIELD OF MONTANA