Provider Demographics
NPI:1134670862
Name:HUNT, JEFFERSON (LAMFT)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:HUNT
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S 3RD E
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2001
Mailing Address - Country:US
Mailing Address - Phone:530-638-5105
Mailing Address - Fax:
Practice Address - Street 1:534 TREJO ST STE 200J
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5408
Practice Address - Country:US
Practice Address - Phone:208-970-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-7049106H00000X
IDLMFT-7471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist