Provider Demographics
NPI:1699957613
Name:MILLER, JESSICA ANN (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3179
Mailing Address - Country:US
Mailing Address - Phone:253-579-3285
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3179
Practice Address - Country:US
Practice Address - Phone:253-579-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00056925101YM0800X
MTSWP-LMFT-LIC-2226106H00000X
MTSWP-LCPC-LIC-5360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist