Healthcare Provider Details

I. General information

NPI: 1629440383
Provider Name (Legal Business Name): SARAH LYTER LPC5904
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 W EMERALD ST SUITE 178
BOISE ID
83704-4854
US

IV. Provider business mailing address

2965 E TARPON DR SUITE 150
MERIDIAN ID
83642-9009
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-7083
  • Fax: 208-321-5069
Mailing address:
  • Phone: 208-287-9420
  • Fax: 208-287-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC5904
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: