Active NPI
Jessica Fetzer, LCPC
- Mental Health Counselor
- Missoula, MT
National Provider Identifier
1104580133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 50615
- Practice address
- 1018 Burlington Ave
Missoula, MT 59801-5675 - Phone
- (801) 560-2920
- NPI assigned
- Oct 26, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 50615 | MT | Primary |
Addresses
Primary practice location
1018 Burlington Ave
Missoula, MT 59801-5675
Mailing address
PO Box 8554
Missoula, MT 59807-8554
Phone (801) 560-2920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50615 | MT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635206400000",
"number": "1104580133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8554",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598078554",
"telephone_number": "801-560-2920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1018 BURLINGTON AVE",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598015675",
"telephone_number": "801-560-2920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETZER",
"first_name": "JESSICA",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-26",
"last_updated": "2021-10-26",
"certification_date": "2021-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MT",
"license": "50615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.