Healthcare Provider Details

I. General information

NPI: 1205992823
Provider Name (Legal Business Name): JAMES KENNETH SESSIONS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 LEXINGTON
IDAHO FALLS ID
83404-4907
US

IV. Provider business mailing address

2101 LEXINGTON
IDAHO FALLS ID
83404-4907
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-9025
  • Fax: 208-535-9022
Mailing address:
  • Phone: 208-535-9025
  • Fax: 208-535-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-140
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC140
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: