Doctor Name: | DR. JACK D NEWSOME |
NPI Number: | 1124169354 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D LCPC |
License Number: | LCPC 3403 |
Business Practice Address: | 732 Washington Ave Pocatello, ID - 832013748 |
Business Phone Number: | 2084789822 |
Business Fax Number: | 2084786790 |
Mailing Address: | 944 Dixon, IDAHO FALLS |
State: | ID |
Postal Code: | 83401 |
Phone Number: | 2084789822 |
Fax Number: | 2084786790 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LCPC 3403 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |