Individual
JACEY JO MAE LANGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
806 SMITH ST., COTTONWOOD, ID 83522
(208) 935-8137
Mailing address
806 SMITH ST., COTTONWOOD, ID 83522
(208) 935-8137
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW-8921871
ID
104100000X
Social Worker
Primary
LMSW-8921871
ID
1041C0700X
Clinical Social Worker
LSW-42591
ID
Other
Enumeration date
09/06/2024
Last updated
03/19/2026
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