| NPI | 1629613823 |
|---|---|
| Doing Business As | JESSICA BULLWINKLE, MA, LMFT |
| Entity Type | Organization |
| Authorized Contact | JESSICA ANGELIC BULLWINKLE Owner 208-231-7308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2021-08-24 |