Healthcare Provider Details

I. General information

NPI: 1518630482
Provider Name (Legal Business Name): YVONNE RENEE IWASA M.A., M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4696 W OVERLAND RD STE 230
BOISE ID
83705-2864
US

IV. Provider business mailing address

1839 S ROOSEVELT ST
BOISE ID
83705-2801
US

V. Phone/Fax

Practice location:
  • Phone: 208-739-3830
  • Fax:
Mailing address:
  • Phone: 208-739-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-8281
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: