Healthcare Provider Details

I. General information

NPI: 1912331299
Provider Name (Legal Business Name): LAURA L. ALLEN-WADE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7161 W POTOMAC DR
BOISE ID
83704-9148
US

IV. Provider business mailing address

11644 W MOUNT HOOD AVE
NAMPA ID
83651-8708
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-6399
  • Fax: 866-275-9883
Mailing address:
  • Phone: 208-409-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5259
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: