Healthcare Provider Details

I. General information

NPI: 1013177567
Provider Name (Legal Business Name): JENA FARID LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENA CASTLE LMFT

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

IV. Provider business mailing address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

V. Phone/Fax

Practice location:
  • Phone: 208-274-3320
  • Fax:
Mailing address:
  • Phone: 208-274-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT125510
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-8584
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: