Individual
JACLYN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2577 S FIVE MILE RD STE 101, BOISE, ID 83709
(208) 639-1897
(208) 639-9957
Mailing address
2577 S FIVE MILE RD STE 101, BOISE, ID 83709-2325
(208) 639-1897
(208) 639-9957
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6879
ID
Other
Enumeration date
06/10/2015
Last updated
08/16/2018
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