| Organization Name: | JJST ENTERPRISES CORP. |
| NPI Number: | 1164723334 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT KAY ANDERSEN (OWNER) |
| Mailing Address: | 343 E 4th N Suite 244 Rexburg |
| State: | ID US |
| Postal Code: | 834406002 |
| Phone Number: | 2083560088 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2010 |
| NPI Last Update Date: | 11/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LCPC-2823 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |