Healthcare Provider Details

I. General information

NPI: 1710001938
Provider Name (Legal Business Name): LEAH FELICE REAGAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

IV. Provider business mailing address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1125
  • Fax: 208-323-9604
Mailing address:
  • Phone: 208-323-1125
  • Fax: 208-323-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-3441
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: