Provider Demographics
NPI:1558456509
Name:JOBE, CINDIE (LCPC;LAC)
Entity Type:Individual
Prefix:MS
First Name:CINDIE
Middle Name:
Last Name:JOBE
Suffix:
Gender:F
Credentials:LCPC;LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-0115
Mailing Address - Country:US
Mailing Address - Phone:406-756-0302
Mailing Address - Fax:406-756-1156
Practice Address - Street 1:1480 MEMORY LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5108
Practice Address - Country:US
Practice Address - Phone:406-756-0302
Practice Address - Fax:406-756-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000250546Medicaid