Individual
JESSICA MINN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
6804 US HIGHWAY 212, RED LODGE, MT 59068-9310
(406) 213-6618
Mailing address
PO BOX 103, RED LODGE, MT 59068-0103
(406) 213-6618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBH-LCPC-LIC-70494
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639895634
NPPES
—
Enumeration date
04/02/2024
Last updated
11/01/2024
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