Provider Demographics
NPI:1447093489
Name:THISTLE, JENNIFER (CLPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:THISTLE
Suffix:
Gender:F
Credentials:CLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E FRONT ST APT A1
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4702
Mailing Address - Country:US
Mailing Address - Phone:406-552-8769
Mailing Address - Fax:
Practice Address - Street 1:114 W PINE ST # 7
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4222
Practice Address - Country:US
Practice Address - Phone:406-274-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-71521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health