Provider Demographics
NPI:1144928508
Name:PULVER, JOCELYN BREANNE (LPC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:BREANNE
Last Name:PULVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 FOREST TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-3716
Mailing Address - Country:US
Mailing Address - Phone:208-869-6903
Mailing Address - Fax:
Practice Address - Street 1:1640 FOREST TRAILS DR
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3716
Practice Address - Country:US
Practice Address - Phone:208-869-6903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-9334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health