MEDICARE: MARIA MITTAG CHALFANT

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	101YM0800X	Mental Health Counselor	5271359	ID

General Provider Information

NPI Number	:	1538055843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MITTAG CHALFANT

Provider Business Mailing Address
First Line	:	1215 N 24TH ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-2304
Country	:	US
Telephone Number	:	208-508-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	9169 W STATE ST STE 272
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-1733
Country	:	US
Telephone Number	:	208-508-2202
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/19/2025

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Directions to “ MARIA MITTAG CHALFANT ” Practice Location

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