Individual
JACK A VENBRUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LCPC, LMHC
Contact information
Practice address
1103 W IRONWOOD DR, COEUR D ALENE, ID 83814-2604
(509) 336-5972
Mailing address
1103 W IRONWOOD DR, COEUR D ALENE, ID 83814-2604
(509) 336-5972
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-6701
ID
101YM0800X
Mental Health Counselor
LH60249089
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC-6701
PROVIDER LICENSE STATE OF IDAHO
ID
01
—
LH60249089
PROVIDER LICENSE WA STATE
WA
Enumeration date
01/10/2008
Last updated
10/25/2018
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