Healthcare Provider Details

I. General information

NPI: 1093499352
Provider Name (Legal Business Name): MATALYNN BELLE EAGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 N COLE RD STE 260
BOISE ID
83704-5976
US

IV. Provider business mailing address

2995 N COLE RD STE 260
BOISE ID
83704-5976
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-5905
  • Fax: 208-888-5513
Mailing address:
  • Phone: 208-888-5905
  • Fax: 208-888-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-9572
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: