Jack, Amanda

Jack, Amanda is an sole proprietor health care provider with primary practice located at 2463 E Gala St , Meridian ID 83642-5209. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Student, Health Care / Student in an Organized Health Care Education/Training Program, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Jack, Amanda can be contacted via phone (208) 955-7333.

Contact Information

Primary practice address
2463 E Gala St Meridian ID 83642-5209
Phone: (208) 955-7333
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Behavioral Health & Social Service Providers / Psychologist 103T00000X

Profile Details

NPI number 1386371235
LBN Legal business name Jack, Amanda
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 2nd, 2022
Last updated Aug 2nd, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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