Provider Demographics
NPI:1245677699
Name:JONES, LISA BETH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:JONES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:2420 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7549
Mailing Address - Country:US
Mailing Address - Phone:208-542-1026
Mailing Address - Fax:
Practice Address - Street 1:2420 E 25TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-542-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional