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General NPI Number Information
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NPI Number | 1275944498
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Entity Type | Organization
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Legal Business Name | CENTRAL IDAHO COUNSELING, PLLC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 125 COMMERCE ST. SUITE B
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City | MCCALL
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State | ID
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Zip | 83638
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Country | US
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Telephone | 208-634-2962
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Fax | 208-634-5064
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Provider Business Mailing Address
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Address Line | 125 COMMERCE ST. SUITE B
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City | MCCALL
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State | ID
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Zip | 83638
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Country | US
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Telephone | 208-634-2962
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Fax | 208-634-5064
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MR. ERIC A MIKKELSEN
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Credential | LMFT
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Telephone | 208-634-2962
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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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