| Doctor Name: | JEFFERY EDMISTON |
| NPI Number: | 1407284698 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., LCPC |
| License Number: | LCPC-5607 |
| Business Practice Address: | 4144 E Amity Ave Nampa, ID - 836878802 |
| Business Phone Number: | 2084654985 |
| Business Fax Number: | 2083180218 |
| Mailing Address: | 4144 E Amity Ave, NAMPA |
| State: | ID |
| Postal Code: | 836878802 |
| Phone Number: | 2084654985 |
| Fax Number: | 2083180218 |
| NPI Enumeration Date: | 10/24/2013 |
| NPI Last Update Date: | 09/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LCPC-5607 |
| 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 |