Organization
CENTRAL MOUNTAINS COUNSELING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB W. WILSON LCSW (OWNER/CLINICIAN)
(208) 630-4040
Entity
Organization
Contact information
Practice address
301 DEINHARD LN, MCCALL, ID 83638-4703
(208) 630-4040
(208) 634-4055
Mailing address
PO BOX 2553, MCCALL, ID 83638-2553
(208) 630-4040
(208) 634-4055
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LCSW-30132
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40230
REGENCE BLUE SHIELD
ID
01
—
8PO33
BLUE CROSS
ID
Enumeration date
11/07/2007
Last updated
01/18/2016
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