Provider Demographics
NPI:1437464666
Name:DEBOER (FARNSWORTH), JESSI S (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:S
Last Name:DEBOER (FARNSWORTH)
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:THREELITTLEBIRDS
Other - Middle Name:LLC
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8031 WILLISTON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-6200
Mailing Address - Country:US
Mailing Address - Phone:802-398-5202
Mailing Address - Fax:
Practice Address - Street 1:8031 WILLISTON RD STE 3
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-6200
Practice Address - Country:US
Practice Address - Phone:802-398-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000536101YA0400X
VT068.0057744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)