Provider Demographics
NPI:1730737024
Name:STOKES, JAQUEL (LPC)
Entity type:Individual
Prefix:MRS
First Name:JAQUEL
Middle Name:
Last Name:STOKES
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 1:254 FORT HENRY LOOP
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2908
Mailing Address - Country:US
Mailing Address - Phone:208-949-8596
Mailing Address - Fax:
Practice Address - Street 1:2590 S 2000 W STE 2
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4028
Practice Address - Country:US
Practice Address - Phone:208-356-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty