Provider Demographics
NPI:1871881565
Name:VENTRESCA, NANCY LEE (EDS MA LCPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:VENTRESCA
Suffix:
Gender:F
Credentials:EDS MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 BIG FLAT RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9704
Mailing Address - Country:US
Mailing Address - Phone:406-240-3150
Mailing Address - Fax:406-329-5989
Practice Address - Street 1:1155 BIG FLAT RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9704
Practice Address - Country:US
Practice Address - Phone:406-240-3150
Practice Address - Fax:406-329-5989
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional