Provider Demographics
NPI:1750677258
Name:BARILLE, JACQUELINE KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE KAY
Middle Name:
Last Name:BARILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE KAY
Other - Middle Name:
Other - Last Name:NENEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 2ND AVE N STE 612
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3287
Mailing Address - Country:US
Mailing Address - Phone:406-478-5858
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 610
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3286
Practice Address - Country:US
Practice Address - Phone:406-478-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1011-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070878OtherBLUE CROSS-SHIELD OF MONTANAN
MT0000070878OtherBLUE CROSS-SHIELD OF MONTANAN