Individual
JEANNINE R WILLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1210 E MAIN ST, CUT BANK, MT 59427-3152
(406) 873-2155
Mailing address
215 S KANSAS ST, CONRAD, MT 59425-1928
(406) 873-2155
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1150
MT
Other
Enumeration date
06/16/2010
Last updated
07/19/2010
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