Individual
MS. ELIZABETH A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1111 S ORCHARD ST STE 100, BOISE, ID 83705-1961
(208) 794-9588
Mailing address
1111 S ORCHARD ST STE 100, BOISE, ID 83705-1961
(208) 794-9588
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW-31478
ID
101YM0800X
Mental Health Counselor
PCSW-535
WY
1041C0700X
Clinical Social Worker
Primary
LCSW-33837
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649694233
—
ID
01
—
3387
LICENSE
ID
Enumeration date
02/18/2014
Last updated
03/03/2024
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