Individual
MS. BEVERLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
210 N HIGGINS AVE, 316, MISSOULA, MT 59802-4462
(406) 542-1313
Mailing address
1440 MOUNTAIN VIEW DR, MISSOULA, MT 59802-3358
(406) 549-6789
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
625
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
625
MT STATE LICENSE
MT
01
—
75135
BLUE CROSS
MT
Enumeration date
07/19/2006
Last updated
07/08/2007
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