Individual
MS. LYNDELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2020 BLAINE ST, CALDWELL, ID 83605-4343
(208) 880-6127
(208) 455-6244
Mailing address
2020 BLAINE ST, CALDWELL, ID 83605-4343
(208) 880-6127
(208) 455-6244
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC234
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016363
REGENCE BLUE SHIELD
ID
01
—
Q1109
BLUE CROSS
ID
Enumeration date
02/10/2007
Last updated
07/09/2007
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