Provider Demographics
NPI:1598358582
Name:SATRE, JACLYN RUBBO (LMFT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:RUBBO
Last Name:SATRE
Suffix:
Gender:F
Credentials:LMFT
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 9405
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9405
Mailing Address - Country:US
Mailing Address - Phone:406-540-0858
Mailing Address - Fax:
Practice Address - Street 1:114 W PINE ST STE 8
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4222
Practice Address - Country:US
Practice Address - Phone:406-540-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120456106H00000X
MT45928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist