Provider Demographics
NPI:1215096474
Name:JONES, CHANTEL (LCPC,NCC)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5023
Mailing Address - Country:US
Mailing Address - Phone:208-375-0167
Mailing Address - Fax:208-395-1948
Practice Address - Street 1:1414 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5023
Practice Address - Country:US
Practice Address - Phone:208-375-0167
Practice Address - Fax:208-395-1948
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010139165OtherBLUE SHIELD
IDQ3444OtherBLUE CROSS
ID2256615OtherCIGNA