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General NPI Number Information
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NPI Number | 1366336174
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Entity Type | Individual
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Provider Name | ABRAHAM MARTIN-MONROE OROS LPC
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Gender | Male
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 820 S LATAH ST STE 110
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City | BOISE
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State | ID
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Zip | 83705-2239
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Country | US
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Telephone | 208-495-4147
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Fax |
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Provider Business Mailing Address
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Address Line | 3029 W MADISON AVE
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City | BOISE
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State | ID
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Zip | 83702-2022
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Country | US
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Telephone | 208-703-2255
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5271768
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5271768
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5271768
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License Number State | ID
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