Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jaxson Layne Stark, MS

Individual provider Mental Health Counselor · NPI 1144559527

Jaxson Layne Stark, MS is a Mental Health Counselor in Ammon, Idaho. Qualified in 2007, 19 years ago. Practices with Pearl Health Clinic, a 38-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
19
Licensed in
ID
In the registry since
2009
What do these letters mean?
MS — Master of Science
A graduate science degree.

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Practice location Address checks out

2705 E 17th St
Ammon, ID 83406-6601
Phone: (208) 360-0067
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LCPC 5501 (ID)

Record details

NPI number1144559527
Entity typeIndividual (Type 1)
GenderMale
Credentials MS
Sole proprietorYes
NPI enumeratedDecember 15, 2009
Last updated in NPPESDecember 6, 2023
Certification dateDecember 6, 2023
Mailing address3770 N Haderlie Ln, Iona, ID 83427-7723

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Pearl Health Clinic — 38 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Ammon