Provider Demographics
NPI:1598017428
Name:PRIMROSE, JENNIFER LEE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:PRIMROSE
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 1:609 S D ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-2141
Mailing Address - Country:US
Mailing Address - Phone:208-650-8510
Mailing Address - Fax:
Practice Address - Street 1:2311 PARK AVE
Practice Address - Street 2:STE 12
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2170
Practice Address - Country:US
Practice Address - Phone:208-678-3555
Practice Address - Fax:208-678-3556
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health