Individual
JERILYNN BLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1510 ROBERT ST, STE 102, BOISE, ID 83705-2528
(208) 429-1865
(208) 429-1865
Mailing address
1510 ROBERT ST, STE 102, BOISE, ID 83705-2528
(208) 724-9502
(208) 429-1865
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3477
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028621
RBSI PROVIDER ID
ID
01
—
Q7106
ID BLUE CROSS PROVIDER ID
ID
Enumeration date
11/14/2006
Last updated
02/14/2024
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