Individual
MR. CHARLES MICHAEL JEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
500 W FORT ST, BLDG 23, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
PO BOX 1364, MOUNTAIN HOME, ID 83647-1364
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-2785
ID
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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