Jaxson Layne Stark, MS

NPI #1144559527 in Ammon, Idaho

Provider Information

NPI Number: 1144559527
Entity Type: Individual
Name: Jaxson Layne Stark, MS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Credential: MS
Enumeration Date: Dec 15, 2009
Last Updated: Dec 6, 2023

Practice Location

Address: 2705 E 17TH ST
City: Ammon
State: Idaho
ZIP Code: 83406-6601
Phone: (208) 360-0067

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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