Venbrux, Jack A

Venbrux, Jack A is an sole proprietor health care provider with primary practice located at 1103 W Ironwood Dr , Coeur D Alene ID 83814-2604. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Venbrux, Jack A can be contacted via phone (509) 336-5972.

Contact Information

Primary practice address
1103 W Ironwood Dr Coeur D Alene ID 83814-2604
Phone: (509) 336-5972
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LH60249089 Washington
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LCPC-6701 Idaho

Profile Details

NPI number 1679759500
LBN Legal business name Venbrux, Jack A
Credentials M.A., LCPC, LMHC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 10th, 2008
Last updated Oct 25th, 2018 - about 8 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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Identifiers

StateTypeNumberIssuer
All States NPI 1679759500 NPPES
Washington Other LH60249089 PROVIDER LICENSE WA STATE
Washington Other LCPC-6701 PROVIDER LICENSE WA STATE

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