Provider Demographics
NPI:1629805577
Name:GERTHE, JESSICA (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GERTHE
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 REMINGTON WAY APT 111
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5458
Mailing Address - Country:US
Mailing Address - Phone:303-704-6026
Mailing Address - Fax:
Practice Address - Street 1:2210 REMINGTON WAY APT 111
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5458
Practice Address - Country:US
Practice Address - Phone:303-704-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-72609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health