Healthcare Provider Details

I. General information

NPI: 1700356268
Provider Name (Legal Business Name): ADRIENNE RAE PATRIDGE MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 W HAYS ST
BOISE ID
83702-5028
US

IV. Provider business mailing address

1312 N 26TH ST
BOISE ID
83702-2323
US

V. Phone/Fax

Practice location:
  • Phone: 208-919-9555
  • Fax: 208-336-7125
Mailing address:
  • Phone: 208-919-9555
  • Fax: 208-336-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: