Provider Demographics
NPI:1497395255
Name:WEISZ, JESSICA MIRANDA ROSE (LCPC, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MIRANDA ROSE
Last Name:WEISZ
Suffix:
Gender:F
Credentials:LCPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 29TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1002
Mailing Address - Country:US
Mailing Address - Phone:805-302-4323
Mailing Address - Fax:
Practice Address - Street 1:108 29TH AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1002
Practice Address - Country:US
Practice Address - Phone:805-302-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-38202101YM0800X
CALPCC10515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health