Provider Demographics
NPI:1013177567
Name:FARID, JENA (LMFT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:FARID
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2101 N LAKEWOOD DR STE 222
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2473
Mailing Address - Country:US
Mailing Address - Phone:208-274-3320
Mailing Address - Fax:
Practice Address - Street 1:2101 N LAKEWOOD DR STE 222
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-274-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT125510106H00000X
106H00000X
IDLMFT-8584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist