Healthcare Provider Details

I. General information

NPI: 1386460384
Provider Name (Legal Business Name): MEGHAN ANN FEENEY ESPOSITO LPC, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S ORCHARD ST STE 128
BOISE ID
83705-1288
US

IV. Provider business mailing address

2020 E MORTIMER CT
BOISE ID
83712-6678
US

V. Phone/Fax

Practice location:
  • Phone: 208-789-1022
  • Fax:
Mailing address:
  • Phone: 208-789-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10377
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: