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General NPI Number Information
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NPI Number | 1336874445
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Entity Type | Individual
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Provider Name | STACI ROCK SOMES LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4337 S MAESAIA WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-9084
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Country | US
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Telephone | 208-607-3639
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191097
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City | BOISE
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State | ID
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Zip | 83719-1097
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Country | US
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Telephone | 208-607-3639
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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 | LPC8965
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License Number State | ID
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