Provider Demographics
NPI:1407161805
Name:ZARAK, JENNIFER ELAINE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:ZARAK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W RAINWATER CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1289
Mailing Address - Country:US
Mailing Address - Phone:208-871-0174
Mailing Address - Fax:
Practice Address - Street 1:870 N LINDER RD
Practice Address - Street 2:SUITE C
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8500
Practice Address - Country:US
Practice Address - Phone:208-871-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional