MEDICARE: MS. STACIA CRISTA CARR LCPC, RPT-S

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	101YP2500X	Professional Counselor	LCPC-3456	ID

General Provider Information

NPI Number	:	1396827234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACIA CRISTA CARR LCPC, RPT-S

Provider Business Mailing Address
First Line	:	560 W CANFIELD AVE STE 300
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7953
Country	:	US
Telephone Number	:	208-758-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W CANFIELD AVE
Second Line	:	STE 300
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7950
Country	:	US
Telephone Number	:	208-758-7111
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/11/2026

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