Organization
PONDEROSA COUNSELING AND THERAPEUTIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE JACOBSEN LCSW (OWNER)
(406) 640-3242
Entity
Organization
Contact information
Practice address
209 S CENTRAL AVE RM 304, WHITE SULPHUR SPRINGS, MT 59645-9086
(406) 640-3242
Mailing address
PO BOX 802, WHITE SULPHUR SPRINGS, MT 59645-1802
(406) 640-3242
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
03/24/2022
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