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NPI: 1700667441 · Individual · Active

Primary Specialty

Mental Health Counselor
Counselor — Mental Health

Practice Location

210 W BURNSIDE AVE
CHUBBUCK, ID 83202-4916 Map ↗
Phone: 435-705-3032

All Specialties & Licenses

  • Mental Health Counselor Primary — Mental Health (license: LMSW-43874, ID)

NPI Registration

Enumerated: 2023-10-09

Last CMS Update: 2023-10-09