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General NPI Number Information
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NPI Number | 1215055868
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Entity Type | Individual
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Provider Name | ELIZABETH MATHES
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 118 N 7TH ST STE C4
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2736
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Country | US
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Telephone | 208-676-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 E LAKESIDE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4137
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Country | US
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Telephone |
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC 200
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License Number State | ID
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