Provider Demographics
NPI:1659675197
Name:HEIDE, JESSE MILLER MUMFORD (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:MILLER MUMFORD
Last Name:HEIDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JESSE
Other - Middle Name:MILLER
Other - Last Name:MUMFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0518
Mailing Address - Country:US
Mailing Address - Phone:406-442-8774
Mailing Address - Fax:406-442-0428
Practice Address - Street 1:501 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2703
Practice Address - Country:US
Practice Address - Phone:406-442-8774
Practice Address - Fax:406-442-0428
Is Sole Proprietor?:No
Enumeration Date:2010-12-24
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid