Individual
JEFFERY EDMISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., LCPC
Contact information
Practice address
4144 E AMITY AVE, NAMPA, ID 83687-8802
(208) 465-4985
(208) 318-0218
Mailing address
4144 E AMITY AVE, NAMPA, ID 83687-8802
(208) 465-4985
(208) 318-0218
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC-5607
ID
Other
Enumeration date
10/24/2013
Last updated
09/25/2014
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