Healthcare Provider Details

I. General information

NPI: 1578379772
Provider Name (Legal Business Name): ALEXANDRA FERRARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA FARRELL FERRARA

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N 6TH ST STE 204
BOISE ID
83702-5980
US

IV. Provider business mailing address

106 N 6TH ST STE 204
BOISE ID
83702-5980
US

V. Phone/Fax

Practice location:
  • Phone: 208-398-3749
  • Fax:
Mailing address:
  • Phone: 208-398-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2661874
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: