Individual
JESSICA C. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
1975 MARTHA AVE, IDAHO FALLS, ID 83404-7580
(208) 529-4300
(208) 529-1627
Mailing address
1975 MARTHA AVE, IDAHO FALLS, ID 83404-7580
(208) 529-4300
(208) 529-1627
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-3413
ID
Other
Enumeration date
10/29/2008
Last updated
10/29/2008
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