Provider Demographics
NPI:1760894612
Name:ADAMS, JESSICA DANIELLE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DANIELLE
Last Name:ADAMS
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 1:3918 S NORTH CHURCH PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5846
Mailing Address - Country:US
Mailing Address - Phone:208-344-5440
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 124
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1210
Practice Address - Country:US
Practice Address - Phone:208-344-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5806101Y00000X
101YA0400X, 101YM0800X, 101YP2500X
IDLPC-5055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional