MEDICARE: GARRETT KROON LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	LCPC-8659	ID

General Provider Information

NPI Number	:	1033688007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT KROON LCPC

Provider Business Mailing Address
First Line	:	2419 E MASSACHUSETTS AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6295
Country	:	US
Telephone Number	:	208-477-8796
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 S MERIDIAN RD STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7962
Country	:	US
Telephone Number	:	208-477-8796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	09/06/2024

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