MEDICARE: MR. JOHN CHRISTOPHER TAGGART JR. LPC

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	LPC-3795	ID

General Provider Information

NPI Number	:	1598922528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CHRISTOPHER TAGGART JR. LPC

Provider Business Mailing Address
First Line	:	2922 EAST CLEVELAND BLVD.
Second Line	:	SUITE 300
City	:	CALDWELL
State	:	ID
Zip	:	83605
Country	:	US
Telephone Number	:	208-880-1341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2922 EAST CLEVELAND BLVD.
Second Line	:	SUITE 300
City	:	CALDWELL
State	:	ID
Zip	:	83605
Country	:	US
Telephone Number	:	208-880-1341
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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