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General NPI Number Information
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NPI Number | 1376790295
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Entity Type | Individual
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Provider Name | JARED DOTSON MCOUN, LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 1740 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6375
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Country | US
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Telephone | 208-529-8832
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Fax | 208-522-8725
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Provider Business Mailing Address
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Address Line | 590 SEMINARY AVE
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City | SHELLEY
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State | ID
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Zip | 83274-1439
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Country | US
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Telephone | 208-403-1984
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Fax | 208-522-8725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-4177
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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