Provider Demographics
NPI:1043824683
Name:BENCE, JACQUELINE (LCPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BENCE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:UREEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1507 BUTLER CREEK AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9655
Mailing Address - Country:US
Mailing Address - Phone:916-837-8460
Mailing Address - Fax:
Practice Address - Street 1:11 W MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3738
Practice Address - Country:US
Practice Address - Phone:916-837-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT42775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health