Provider Demographics
NPI:1629389531
Name:JARVIS, MARY CATHERINE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:JARVIS
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 1:7275 W POTOMAC DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9171
Mailing Address - Country:US
Mailing Address - Phone:208-994-1569
Mailing Address - Fax:208-944-0155
Practice Address - Street 1:7275 W POTOMAC DR STE 110
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9171
Practice Address - Country:US
Practice Address - Phone:208-994-1569
Practice Address - Fax:208-944-0155
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health