Provider Demographics
NPI:1356894620
Name:JEWELL, JEFFREY LLOYD (LPC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LLOYD
Last Name:JEWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SHERRY DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7020
Mailing Address - Country:US
Mailing Address - Phone:208-731-9855
Mailing Address - Fax:
Practice Address - Street 1:1092 EASTLAND DR N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8442
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health