Individual
MELODY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
699 FARMHOUSE LN, BOZEMAN, MT 59715-9402
(406) 556-6500
(406) 333-0627
Mailing address
699 FARMHOUSE LN, BOZEMAN, MT 59715-9402
(406) 556-6500
(406) 333-0627
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBH-LCPC-LIC-29806
MT
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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