JAXSON STARK, MS

Counselor - Mental Health

Active Individual
NPI: 1144559527

Practice Address

2705 E 17TH ST
Ammon, ID 83406

Phone: (208) 360-0067

Specialties

Specialty Code Primary License
Counselor - Mental Health 101YM0800X Yes LCPC 5501 (ID)

Frequently Asked Questions

NPI 1144559527 is the National Provider Identifier for JAXSON STARK, MS, a Counselor - Mental Health provider located in Ammon, ID. This NPI was enumerated on December 15, 2009.
JAXSON STARK, MS practices at 2705 E 17TH ST, Ammon, ID 83406.

Quick Facts

NPI
1144559527
Type
Individual
Enumerated
Dec 15, 2009
Last Updated
Dec 6, 2023

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