Individual provider · Type 1 NPI

Jessie Elaine Sullivan, LCPC, LMFT

Mental Health Counselor · Idaho Falls, ID

NPI number 1063674786 Active

Practice location

660 S Woodruff Ave
Idaho Falls, ID 83401-5299

Call (208) 523-1558 Map

Fax (208) 529-4788

Mailing address

3785 Colts Glen Ln
Idaho Falls, ID 83404-8353

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLCPC-119 (ID)
Marriage & Family Therapist 106H00000XLMFT-2963 (ID)

Mental Health Counselor: Definition to come...

2 other providers at this address

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About NPI 1063674786

Jessie Elaine Sullivan, LCPC, LMFT's National Provider Identifier is 1063674786, issued on Jun 25, 2008. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Idaho Falls, ID. The record was last updated on Jun 16, 2011.