Provider Demographics
NPI:1821587304
Name:JAYNE ROSSO SEABROOK COUNSELING, LLC
Entity type:Organization
Organization Name:JAYNE ROSSO SEABROOK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:ROSSO
Authorized Official - Last Name:SEABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-360-3730
Mailing Address - Street 1:PO BOX 3453
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-3453
Mailing Address - Country:US
Mailing Address - Phone:406-360-3730
Mailing Address - Fax:
Practice Address - Street 1:800 KENSINGTON AVE STE LL2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5670
Practice Address - Country:US
Practice Address - Phone:406-360-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-123611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5C0F57BA44Medicaid