Healthcare Provider Details

I. General information

NPI: 1356526107
Provider Name (Legal Business Name): JACOB HELLENKAMP LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 N CISCO LN
BOISE ID
83702-5536
US

IV. Provider business mailing address

2630 N CISCO LN
BOISE ID
83702-5536
US

V. Phone/Fax

Practice location:
  • Phone: 253-353-0396
  • Fax:
Mailing address:
  • Phone: 253-353-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5381511
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: