Provider Demographics
NPI:1790833424
Name:MJ COUNSELING AND CASE MANAGEMENT
Entity Type:Organization
Organization Name:MJ COUNSELING AND CASE MANAGEMENT
Other - Org Name:MJ SOCIAL SERVICES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNERADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-365-3183
Mailing Address - Street 1:2328 MOUNTAIN VIEW DR
Mailing Address - Street 2:BOX 130
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9533
Mailing Address - Country:US
Mailing Address - Phone:208-365-3183
Mailing Address - Fax:208-365-2307
Practice Address - Street 1:2328 MOUNTAIN VIEW DR
Practice Address - Street 2:BOX 130
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9533
Practice Address - Country:US
Practice Address - Phone:208-365-3183
Practice Address - Fax:208-365-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC148733171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002748300Medicaid