Healthcare Provider Details

I. General information

NPI: 1487308060
Provider Name (Legal Business Name): ABIGAIL GOTTO LPC, ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL FERGUSON

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7203 E COLUMBIA RD
BOISE ID
83716-9600
US

IV. Provider business mailing address

2225 GEM AVE
EMMETT ID
83617-9625
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-9990
  • Fax:
Mailing address:
  • Phone: 360-265-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13744922-6009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5771049
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: