Provider Demographics
NPI:1558176560
Name:SIFUENTES, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIFUENTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N ACER LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-1098
Mailing Address - Country:US
Mailing Address - Phone:208-576-4316
Mailing Address - Fax:
Practice Address - Street 1:819 N ACER LOOP
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-1098
Practice Address - Country:US
Practice Address - Phone:208-576-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health