1558456509 NPI number — MS. CINDIE JOBE LCPC;LAC

Table of content: MS. CINDIE JOBE LCPC;LAC (NPI 1558456509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558456509 NPI number — MS. CINDIE JOBE LCPC;LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOBE
Provider First Name:
CINDIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC;LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558456509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59903-0115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-756-0302
Provider Business Mailing Address Fax Number:
406-756-1156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1480 MEMORY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-5108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-756-0302
Provider Business Practice Location Address Fax Number:
406-756-1156
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  802 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000250546 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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