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NPI Code Detail

MEDICARE: ALLISON RENEE WILLETS LCPC, CMHC

MEDICARE:   ALLISON RENEE WILLETS  LCPC, CMHC
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1043807712
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON RENEE WILLETS LCPC, CMHC
Provider Business Mailing Address
First Line : 5418 N EAGLE RD STE 160
Second Line :
City : BOISE
State : ID
Zip : 83713-0100
Country : US
Telephone Number : 208-856-4859
Fax Number :
Provider Business Practice Location Address
First Line : 5418 N EAGLE RD STE 160
Second Line :
City : BOISE
State : ID
Zip : 83713-0100
Country : US
Telephone Number : 208-856-4859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2020
Last Update Date : 06/20/2024

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Directions to “ ALLISON RENEE WILLETS LCPC, CMHC” Practice Location

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