Healthcare Provider Details

I. General information

NPI: 1609532167
Provider Name (Legal Business Name): JAYCE LEHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 E 17TH ST
IDAHO FALLS ID
83404-6126
US

IV. Provider business mailing address

4540 S CAMERON LN
REXBURG ID
83440-4373
US

V. Phone/Fax

Practice location:
  • Phone: 208-346-0688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10382488-3502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861915
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: