Healthcare Provider Details

I. General information

NPI: 1649923905
Provider Name (Legal Business Name): JASON WILLIAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TARRAGON WAY
CALDWELL ID
83605-1164
US

IV. Provider business mailing address

222 TARRAGON WAY
CALDWELL ID
83605-1164
US

V. Phone/Fax

Practice location:
  • Phone: 208-310-9710
  • Fax:
Mailing address:
  • Phone: 208-310-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61671194
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8331429
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8331429
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9345
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: