Organization
NORTHWEST NEUROBEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER A LA JEUNESSE LCSW, CMPE (CO-OWNER)
(208) 283-9121
Entity
Organization
Contact information
Practice address
2076 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 955-7333
Mailing address
2076 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 955-7333
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY-202425
ID
103TC0700X
Clinical Psychologist
PSY-202505
ID
104100000X
Social Worker
LMSW-29787
ID
104100000X
Social Worker
LMSW-30636
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-28431
ID
235Z00000X
Speech-Language Pathologist
SLP-1687
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369079
MEDICARE PTAN
ID
Enumeration date
08/23/2010
Last updated
08/17/2015
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