Individual
DR. JACK D NEWSOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D LCPC
Contact information
Practice address
732 WASHINGTON AVE, POCATELLO, ID 83201-3748
(208) 478-9822
(208) 478-6790
Mailing address
944 DIXON, IDAHO FALLS, ID 83401
(208) 478-9822
(208) 478-6790
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC 3403
ID
Other
Enumeration date
02/09/2007
Last updated
07/09/2007
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