Provider Demographics
NPI:1659385490
Name:KELLY, JEANNETTE MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:KELLY
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 1:1545 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7375
Mailing Address - Country:US
Mailing Address - Phone:406-442-7727
Mailing Address - Fax:
Practice Address - Street 1:900 N 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:406-443-3420
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT546 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000074918OtherBLUECROSS/SHIELD OF MONT