Healthcare Provider Details

I. General information

NPI: 1902447238
Provider Name (Legal Business Name): THERESA ERBE-NEUBERGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14954 N COEUR DALENE ST
RATHDRUM ID
83858-6484
US

IV. Provider business mailing address

14954 N COEUR DALENE ST
RATHDRUM ID
83858-6484
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-0538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number38758
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: