Provider Demographics
NPI:1568124139
Name:SELLMAN, JESSICA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SELLMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6807
Mailing Address - Country:US
Mailing Address - Phone:208-417-0623
Mailing Address - Fax:
Practice Address - Street 1:4737 S AFTON PL STE A
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2317
Practice Address - Country:US
Practice Address - Phone:208-417-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8172101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor