Provider Demographics
NPI:1093229346
Name:JONES, ANITA ENGSTROM (LCPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ENGSTROM
Last Name:JONES
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5419
Mailing Address - Country:US
Mailing Address - Phone:208-312-0798
Mailing Address - Fax:208-878-2248
Practice Address - Street 1:144 E HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5427
Practice Address - Country:US
Practice Address - Phone:208-312-0798
Practice Address - Fax:208-878-2248
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2786106H00000X
ID3112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty