Provider Demographics
NPI:1386336410
Name:GILLEY, JENNIFER LYNETTE (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNETTE
Last Name:GILLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W GEORGIA AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6812
Mailing Address - Country:US
Mailing Address - Phone:208-941-2981
Mailing Address - Fax:
Practice Address - Street 1:217 W GEORGIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6812
Practice Address - Country:US
Practice Address - Phone:208-498-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IDLMSW-42536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)