Provider Demographics
NPI:1871300160
Name:JAGER, VICTORIA (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JAGER
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LAFORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, PCLC
Mailing Address - Street 1:516 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-1443
Mailing Address - Country:US
Mailing Address - Phone:360-640-4912
Mailing Address - Fax:
Practice Address - Street 1:516 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-1443
Practice Address - Country:US
Practice Address - Phone:360-640-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-74928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health