Basic Information
Provider Information
NPI: 1104152982
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON
FirstName: JANEIL
MiddleName: E
NamePrefix: MRS.
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3212 1ST AVE S
Address2:  
City: BILLINGS
State: MT
PostalCode: 591013814
CountryCode: US
TelephoneNumber: 4062452751
FaxNumber: 4062567026
Practice Location
Address1: 1000 ROCKFORK CIR
Address2:  
City: LAUREL
State: MT
PostalCode: 590441848
CountryCode: US
TelephoneNumber: 4066553307
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/28/2009
LastUpdateDate: 06/11/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X1369MTY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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