Healthcare Provider Details

I. General information

NPI: 1093229346
Provider Name (Legal Business Name): ANITA ENGSTROM JONES LCPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 E HIGHWAY 81
BURLEY ID
83318-5427
US

IV. Provider business mailing address

475 RIVERSIDE DR
BURLEY ID
83318-5419
US

V. Phone/Fax

Practice location:
  • Phone: 208-312-0798
  • Fax: 208-878-2248
Mailing address:
  • Phone: 208-312-0798
  • Fax: 208-878-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3112
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2786
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: