Jacqueline Bazzle, LPC
Individual provider Active NPI Professional Counselor · Boise, ID
NPI 1669844320 · NPPES record last updated Dec 16, 2020
Key facts
- NPI
- 1669844320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC5973 (ID)
- Practice address
- 6126 W State St # 409
Boise, ID 83703-2741 - Phone
- (208) 376-7083
- Fax
- (208) 321-5069
- NPI assigned
- Oct 21, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC5973 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Something Different Counseling LLC | Professional | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC5973 | ID | Yes |
Addresses
Primary practice location
6126 W State St # 409
Boise, ID 83703-2741
Mailing address
6126 W State St # 409
Boise, ID 83703-2741
Phone (208) 287-9420
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC5973 | Other | ID | STATE LICENSE |
Other names
- Jacqueline Cheri Smithee
Other providers in Boise, ID
- Mikaela Bayless
- Jessica Marie Baylis
- Lauren Anne Bayuk
- Malinda S Baze
- Rachael Bazzett
- BCS PA
- Floyd Bea
- Ann Pendleton Beach
- Cory Beach
- Kelly Beach
All providers in Boise, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.