Individual
STACY JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 E BROADWAY ST STE 204, MISSOULA, MT 59802-4592
(406) 370-4664
Mailing address
110 E BROADWAY ST STE 204, MISSOULA, MT 59802-4592
(406) 370-4664
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4670
MT
106H00000X
Marriage & Family Therapist
4925
MT
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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