1659675197 NPI number — MRS. JESSE MILLER MUMFORD HEIDE LCSW

Table of content: MRS. JESSE MILLER MUMFORD HEIDE LCSW (NPI 1659675197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659675197 NPI number — MRS. JESSE MILLER MUMFORD HEIDE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIDE
Provider First Name:
JESSE
Provider Middle Name:
MILLER MUMFORD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUMFORD
Provider Other First Name:
JESSE
Provider Other Middle Name:
MILLER
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659675197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59624-0518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-442-8774
Provider Business Mailing Address Fax Number:
406-442-0428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-442-8774
Provider Business Practice Location Address Fax Number:
406-442-0428
Provider Enumeration Date:
12/24/2010

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: 1041C0700X , with the licence number:  978 , 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)





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