Provider Demographics
NPI:1558605113
Name:MAMMENGA, JAMIE LYNN-MCBRIDE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN-MCBRIDE
Last Name:MAMMENGA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:MAMMENGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:944 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3346
Mailing Address - Country:US
Mailing Address - Phone:406-696-5258
Mailing Address - Fax:855-632-2807
Practice Address - Street 1:944 AVENUE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3346
Practice Address - Country:US
Practice Address - Phone:406-696-5258
Practice Address - Fax:855-632-2807
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60985147101YM0800X
MTBBH-LCPC-LIC-64820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health