NPI age
19 years
Enumerated 2007-05-25
Across 1998 active counselor providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | Q2735 | BLUE CROSS |
| 01 (ID) | LCPC-95 | IDAHO STATE LIC NUMBER |
| 01 (ID) | 000010015793 | BLUE SHIELD |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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