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General NPI Number Information
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NPI Number | 1205220027
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Entity Type | Individual
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Provider Name | GWENDOLYN GAUSE LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 1401 S WARDLE ST
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City | BOISE
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State | ID
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Zip | 83705-2931
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Country | US
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Telephone | 208-412-0122
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Fax | 208-537-5730
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Provider Business Mailing Address
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Address Line | 3527 S FEDERAL WAY STE 103-417
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City | BOISE
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State | ID
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Zip | 83705-5204
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Country | US
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Telephone | 208-412-0122
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Fax | 208-537-5730
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | ID
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