Provider Demographics
NPI:1972690147
Name:TRIPLETT, JUANITA NANCY (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:NANCY
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:MA, LCPC
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 1234
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1234
Mailing Address - Country:US
Mailing Address - Phone:406-827-3357
Mailing Address - Fax:
Practice Address - Street 1:300 NOXON AVE
Practice Address - Street 2:
Practice Address - City:NOXON
Practice Address - State:MT
Practice Address - Zip Code:59853-9762
Practice Address - Country:US
Practice Address - Phone:406-827-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional