Provider Demographics
NPI:1659858629
Name:STANLEY, JENNIE LYNN (MS, NCC, LCPC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYNN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W KAGY BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6042
Mailing Address - Country:US
Mailing Address - Phone:406-224-4135
Mailing Address - Fax:
Practice Address - Street 1:121 W KAGY BLVD STE N
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6042
Practice Address - Country:US
Practice Address - Phone:406-224-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31669101YP2500X, 101YM0800X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist