Individual
JEREMY WALLACE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
1411 MAIN ST STE B-C, BILLINGS, MT 59105-1712
(406) 606-9552
Mailing address
1411 MAIN ST # B-C, BILLINGS, MT 59105-1712
(406) 606-9552
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
31177
MT
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
06/02/2011
Last updated
08/31/2020
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