person
Jaxson Layne Stark, MS
Mental Health Counselor in Ammon, Idaho
NPI 1144559527

Jaxson Layne Stark is a Mental Health Counselor based in Iona, ID and is specialized in Mental Health. Jaxson Layne Stark practices in Ammon, ID and has the professional credentials of MS. The NPI Number for Jaxson Layne Stark is 1144559527 and holds a License No. LCPC 5501 (Idaho).

The current practice location address for Jaxson Layne Stark is 2705 E 17Th St, Ammon, ID and can be reached out via phone at 208-360-0067. You can also correspond with Jaxson Layne Stark through the mailing address at 3770 N HADERLIE LN, IONA, ID - 83427-7723 (mailing address contact number: 208-360-0067).

Location: 2705 E 17Th St, Ammon, ID, 83427-7723
person
Provider Profile Details
NPI Number
1144559527
Provider Name
Jaxson Layne Stark
Credential
MS
Provider Entity Type
Individual
Gender
Male
Address
2705 E 17Th St, Ammon, ID, 83427-7723
Phone Number
208-360-0067
Fax Number
Provider Enumeration Date
12/15/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2705 E 17Th St
City
State
Zip
83406-6601
Phone Number
208-360-0067
Fax Number
person
Provider Business Mailing Address Details
Address
2705 E 17Th St
City
State
Zip
83406-6601
Phone Number
208-360-0067
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
LCPC 5501 (Idaho)
Definition
Definition to come...
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