Individual
MS. JESSIE ELAINE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC,LMFT
Contact information
Practice address
660 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 523-1558
(208) 529-4788
Mailing address
3785 COLTS GLEN LN, IDAHO FALLS, ID 83404-8353
(208) 524-2411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-119
ID
106H00000X
Marriage & Family Therapist
LMFT-2963
ID
Other
Enumeration date
06/25/2008
Last updated
06/16/2011
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