Provider Demographics
NPI:1902615313
Name:JASSO, ELIJAHBEN (PCLC, NCC)
Entity type:Individual
Prefix:
First Name:ELIJAHBEN
Middle Name:
Last Name:JASSO
Suffix:
Gender:M
Credentials:PCLC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1902
Mailing Address - Country:US
Mailing Address - Phone:307-272-7042
Mailing Address - Fax:
Practice Address - Street 1:1250 15TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4155
Practice Address - Country:US
Practice Address - Phone:406-247-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-55503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health