Individual
KEATON JAKE SUITTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
502 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5298
(208) 346-7500
Mailing address
502 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5298
(208) 346-7500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-9695
ID
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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