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General NPI Number Information
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NPI Number | 1952808073
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Entity Type | Organization
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Legal Business Name | JILLIAN WINTERS
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 1524 W HAYS ST STE 201
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City | BOISE
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State | ID
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Zip | 83702-4035
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Country | US
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Telephone | 208-971-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 W HAYS ST STE 201
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City | BOISE
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State | ID
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Zip | 83702-4035
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Country | US
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Telephone | 208-971-1220
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | JILLIAN WINTERS
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Credential | MA, LCPC, NCC
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Telephone | 208-971-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6605
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License Number State | ID
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