Provider Demographics
NPI:1881073914
Name:HANDRAN, JODI JILL (LCCC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:JILL
Last Name:HANDRAN
Suffix:
Gender:F
Credentials:LCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 FAIRVIEW AVE STE 247
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7821
Mailing Address - Country:US
Mailing Address - Phone:406-499-2307
Mailing Address - Fax:
Practice Address - Street 1:1515 FAIRVIEW AVE STE 247
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7821
Practice Address - Country:US
Practice Address - Phone:406-499-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17584101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral