Jacqueline Moore, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4861472 Issued in ID

Practice address

3288 E Pine Ave
Meridian, ID 83642-5922

Phone

(208) 888-8886

NPI assigned

Dec 11, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 7, 2025 through Apr 7, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Journey Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Meridian, ID
  • NPI 1316272248
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1245047463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1447 W WHITEHALL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427317",
            "telephone_number": "801-808-4129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3288 E PINE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425922",
            "telephone_number": "208-888-8886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "690 S Industry Way Ste 45",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836427907",
            "country_code": "US",
            "telephone_number": "801-808-4129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACQUELINE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-11",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "4861472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy Monello
• Cynthia Montgomery
• Jolynn Montgomery, PA-C
• Spencer Montgomery, MD
• Sebastian Patrick Mooney, PHARMD
• Karleigh Danielle Moore, MOTR/L
• Aaron Blain Moorhouse, DO
• Aaron Drew Moorhouse, DO
• Michael Joshua Moorhouse, D.C.
• Leann Leslie Mora, LCSW

• Professional Counselor in Meridian, ID
• Providers in Meridian, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.