Healthcare Provider Details

I. General information

NPI: 1962961391
Provider Name (Legal Business Name): ALLISON HOBBY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8590 W FAIRVIEW AVE
BOISE ID
83704-8320
US

IV. Provider business mailing address

8590 W FAIRVIEW AVE
BOISE ID
83704-8320
US

V. Phone/Fax

Practice location:
  • Phone: 208-672-0260
  • Fax:
Mailing address:
  • Phone: 208-672-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-7162
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: