JAXSON LAYNE STARK

AMMON, ID
NPI1144559527
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: ID  LCPC 5501)
Enumeration Date2009-12-15
Last Update Date2023-12-06
Business Address
JAXSON LAYNE STARK MS
2705 E 17TH ST
AMMON, ID 83406-6601
Phone number: 208-360-0067
Mailing Address
JAXSON LAYNE STARK MS
3770 N HADERLIE LN
IONA, ID 83427-7723
Phone number: 208-360-0067
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