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JCW PSYCHIATRY PLLC

JCW PSYCHIATRY PLLC

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Company Details

Name:	JCW PSYCHIATRY PLLC
Jurisdiction:	Idaho
Legal type:	Limited Liability Company (D)
Status:	Active-Existing
Date of registration:	14 Feb 2020 (5 years ago)
Financial Date End:	28 Feb 2026
Entity Number:	3782026
Place of Formation:	IDAHO
File Number:	699313
ZIP code:	83318
County:	Cassia County
Principal Address:	JACOB WHITE 125 S 650 E BURLEY, ID 83318
Mailing Address:	JACOB WHITE STE 10 413 N ALLUMBAUGH ST BOISE, ID 83704-9212

Agent

Name	Role	Address
Jacob C White	Agent	3727 E LAKE HAZEL RD, MERIDIAN, ID 83642

Member

Name	Role	Address	Appointed On
Jacob C White	Member	413 N ALLUMBAUGH STREET, BOISE, ID 83704	2021-02-03

National Provider Identifier

NPI Number:

1861001687

Certification Date:

2020-07-28

Link:

View on NPI website

Authorized Person:

Name:

CHERI PETERSON

Role:

CREDENTIALER

Phone:

2089545594

Taxonomy:

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

Yes

Contacts:

Phone:

+1 208-323-1125

Fax:

2083239604

Filing

Filing Name	Filing Number	Filing date
Annual Report	0006071229	2025-01-15
Annual Report	0005634816	2024-03-05
Annual Report	0005055359	2023-01-05
Annual Report	0004547244	2022-01-03
Annual Report	0004153846	2021-02-03

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State