Individual
MS. SALLY JO LEYSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
601A PIONEER MOUNTAIN LOOP, JEROME, ID 83338-6557
(208) 420-5902
Mailing address
601A PIONEER MOUNTAIN LOOP, JEROME, ID 83338-6557
(208) 420-5902
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-215
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017683
BLUE SHIELD
ID
01
—
12249540
CAQH
ID
01
—
Q215-6
BLUE CROSS
ID
Enumeration date
08/10/2006
Last updated
10/29/2014
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