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General NPI Number Information
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NPI Number | 1245735422
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Entity Type | Individual
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Provider Name | DESTINEE JO BLAMIRES LPC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 540 S 16TH ST STE 118
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City | PAYETTE
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State | ID
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Zip | 83661-3514
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Country | US
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Telephone | 208-546-2406
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Fax |
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Provider Business Mailing Address
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Address Line | 5176 CALEB CT
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City | FRUITLAND
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State | ID
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Zip | 83619-3816
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Country | US
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Telephone | 208-546-2406
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-6728
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-6728
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License Number State | ID
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