Provider Demographics
NPI:1881381283
Name:PENCE, BRIDGETTE BRIANNE (PCLC)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:BRIANNE
Last Name:PENCE
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 38TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6817
Mailing Address - Country:US
Mailing Address - Phone:406-459-4225
Mailing Address - Fax:
Practice Address - Street 1:101 38TH AVE NW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6817
Practice Address - Country:US
Practice Address - Phone:406-459-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-57474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional