Individual
JESSE ALLEGRA MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6932 S HUNT WAY, BOISE, ID 83709-1564
(208) 230-4461
Mailing address
10673 W LAKE HAZEL RD # 50, BOISE, ID 83709-5453
(208) 230-4461
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC8353
ID
101YP2500X
Professional Counselor
Primary
LPC8353
ID
Other
Enumeration date
10/11/2021
Last updated
12/28/2023
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