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General NPI Number Information
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NPI Number | 1326820622
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Entity Type | Individual
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Provider Name | MAREN BERRETT
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Gender | Female
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 534 TREJO ST STE 200F
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City | REXBURG
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State | ID
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Zip | 83440-5429
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Country | US
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Telephone | 208-499-4517
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Fax |
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Provider Business Mailing Address
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Address Line | 449 W 7TH S
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City | SAINT ANTHONY
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State | ID
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Zip | 83445-1906
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Country | US
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Telephone | 801-471-5128
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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