Provider Demographics
NPI:1134137318
Name:MCCOLL, JENNY CALLAO (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:CALLAO
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1836
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701
Mailing Address - Country:US
Mailing Address - Phone:208-344-0687
Mailing Address - Fax:208-395-1948
Practice Address - Street 1:1408 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5028
Practice Address - Country:US
Practice Address - Phone:208-344-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional