Individual provider · Type 1 NPI

Jaxson Layne Stark, MS

Mental Health Counselor · Ammon, ID

NPI number 1144559527 Active

Practice location

2705 E 17th St
Ammon, ID 83406-6601

Mailing address

3770 N Haderlie Ln
Iona, ID 83427-7723

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLCPC 5501 (ID)

Mental Health Counselor: Definition to come...

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About NPI 1144559527

Jaxson Layne Stark, MS's National Provider Identifier is 1144559527, issued on Dec 15, 2009. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Ammon, ID. The record was last updated on Dec 6, 2023.