Provider Demographics
NPI:1679365423
Name:CHIPMAN, JAYANN (R-DMT, PCLC)
Entity type:Individual
Prefix:
First Name:JAYANN
Middle Name:
Last Name:CHIPMAN
Suffix:
Gender:F
Credentials:R-DMT, PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MT
Mailing Address - Zip Code:59922-9710
Mailing Address - Country:US
Mailing Address - Phone:406-370-4575
Mailing Address - Fax:
Practice Address - Street 1:139 MONACO DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9710
Practice Address - Country:US
Practice Address - Phone:406-370-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-79272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health