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General NPI Number Information
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NPI Number | 1215794805
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Entity Type | Organization
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Legal Business Name | MAH COUNSELING AND CONSULTING INC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 3152 S BOWN WAY STE 201
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City | BOISE
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State | ID
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Zip | 83706-5463
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Country | US
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Telephone | 208-336-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 1136 N ROPER PL
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City | MERIDIAN
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State | ID
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Zip | 83642-8508
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Country | US
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Telephone | 208-870-1626
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CONNIE ANDREA GARDNER
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Credential |
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Telephone | 82-870-1626
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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 |
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