Provider Demographics
NPI:1407984966
Name:SPRAGUE, JILL JANAY (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JANAY
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:JANAY
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2530 S SUBSTATION RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617
Mailing Address - Country:US
Mailing Address - Phone:208-739-0864
Mailing Address - Fax:
Practice Address - Street 1:829B S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3528
Practice Address - Country:US
Practice Address - Phone:208-365-3141
Practice Address - Fax:208-398-8311
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010035506OtherBLUE SHIELD OF IDAHO
IDQ5886OtherBLUE CROSS OF IDAHO
ID807062700Medicaid