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General NPI Number Information
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NPI Number | 1215222138
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Entity Type | Organization
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Legal Business Name | INNER BALANCE COUNSELING LLC
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 216 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5013
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Country | US
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Telephone | 208-965-8180
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Fax |
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Provider Business Mailing Address
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Address Line | 216 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-5013
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Country | US
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Telephone | 208-965-8180
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Fax |
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Authorized Official
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Title or Position | LLC MANAGER, PROFESSIONAL COUNSELOR
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Name | MR. JOESPH A. BUGHER
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Credential | LPC
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Telephone | 208-965-8180
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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 | LPC-4628
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License Number State | ID
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