Healthcare Provider Details

I. General information

NPI: 1598660748
Provider Name (Legal Business Name): JORDAN SCOTT GARNER LCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 E STATE AVE
MERIDIAN ID
83642
US

IV. Provider business mailing address

36 E STATE AVE
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-760-8175
  • Fax:
Mailing address:
  • Phone: 208-760-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7581917
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: