Healthcare Provider Details

I. General information

NPI: 1992612675
Provider Name (Legal Business Name): JAMESON CADE DEVINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 PARKWAY DR
BLACKFOOT ID
83221-1657
US

IV. Provider business mailing address

3910 E 485 N
RIGBY ID
83442-5758
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-2410
  • Fax:
Mailing address:
  • Phone: 208-346-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: