Individual
JACQUELINE BAZZLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6126 W STATE ST # 409, BOISE, ID 83703-2741
(208) 376-7083
(208) 321-5069
Mailing address
6126 W STATE ST # 409, BOISE, ID 83703-2741
(208) 287-9420
(208) 287-9426
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC5973
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC5973
STATE LICENSE
ID
Enumeration date
10/21/2015
Last updated
12/16/2020
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