Provider Demographics
NPI:1851784987
Name:FARNSWORTH, JEANNE MARIE HETTICH (LPCC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE HETTICH
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:HETTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 SHADY ACRES ST NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3833
Mailing Address - Country:US
Mailing Address - Phone:605-281-0528
Mailing Address - Fax:701-255-4495
Practice Address - Street 1:103 SHADY ACRES ST NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3833
Practice Address - Country:US
Practice Address - Phone:605-281-0528
Practice Address - Fax:701-255-4495
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND825-3-1-15A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health