Provider Demographics
NPI:1649611351
Name:LEJEUNE, BROOKE JADE (LCAC)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:JADE
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:JADE
Other - Last Name:SELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAC
Mailing Address - Street 1:101 E BROADWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-222-0386
Mailing Address - Fax:701-255-4891
Practice Address - Street 1:520 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2968
Practice Address - Country:US
Practice Address - Phone:701-253-6300
Practice Address - Fax:701-253-6400
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1712101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)