Provider Demographics
NPI:1689713224
Name:BOEHM, JENNIFER BETH SHELL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BETH SHELL
Last Name:BOEHM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BETH
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3334 SPARROW HAWK DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4984
Mailing Address - Country:US
Mailing Address - Phone:208-681-4766
Mailing Address - Fax:
Practice Address - Street 1:3544 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6913
Practice Address - Country:US
Practice Address - Phone:208-681-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional