Provider Demographics
NPI:1063602266
Name:ALLICK, JESSIE L (LCPC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:ALLICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1017
Mailing Address - Country:US
Mailing Address - Phone:406-496-6314
Mailing Address - Fax:406-474-1724
Practice Address - Street 1:1601 TAMMANY ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1845
Practice Address - Country:US
Practice Address - Phone:406-563-7365
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1124OtherSTATE OF MONTANA LICENSE