Healthcare Provider Details

I. General information

NPI: 1205141389
Provider Name (Legal Business Name): ANITA ELDERKIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 E RIVERPARK LN
BOISE ID
83706-4066
US

IV. Provider business mailing address

671 E RIVERPARK LN
BOISE ID
83706-4066
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-2071
  • Fax:
Mailing address:
  • Phone: 208-338-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-5122
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: