Healthcare Provider Details

I. General information

NPI: 1609298165
Provider Name (Legal Business Name): JESSICA CROCKETT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 N IDAHO ST STE 7
POST FALLS ID
83854-9024
US

IV. Provider business mailing address

1224 N IDAHO ST STE 7
POST FALLS ID
83854-9024
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-5467
  • Fax:
Mailing address:
  • Phone: 509-944-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60781554
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number60883000
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: