Individual
JAMIE LYNN VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
600 E RIVERPARK LN STE 125, BOISE, ID 83706-6661
(208) 850-9186
Mailing address
600 E RIVERPARK LN STE 125, BOISE, ID 83706-6661
(208) 850-9186
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
LPC 5951
ID
Other
Enumeration date
05/14/2014
Last updated
12/05/2018
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