Provider Demographics
NPI:1427673177
Name:HELLERUD, JAYE DANIELE (ACLC)
Entity type:Individual
Prefix:
First Name:JAYE
Middle Name:DANIELE
Last Name:HELLERUD
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2212
Mailing Address - Country:US
Mailing Address - Phone:406-425-1493
Mailing Address - Fax:
Practice Address - Street 1:2120 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2212
Practice Address - Country:US
Practice Address - Phone:406-425-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT43341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-ACLC-LIC-43341Medicaid