Provider Demographics
NPI:1013161009
Name:SABO, JACQUELINE W (LCPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:W
Last Name:SABO
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:WILDFLOWER COUNSELING, LLC
Mailing Address - Street 2:1123 12TH AVE RD, #274
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5738
Mailing Address - Country:US
Mailing Address - Phone:208-315-6640
Mailing Address - Fax:
Practice Address - Street 1:WILDFLOWER COUNSELING, LLC
Practice Address - Street 2:104 9TH AVE S STE B2
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3809
Practice Address - Country:US
Practice Address - Phone:208-993-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional