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General NPI Number Information
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NPI Number | 1417024209
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Entity Type | Organization
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Legal Business Name | CALDWELL COUNSELING ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2020 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605-4343
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Country | US
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Telephone | 208-880-6127
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Fax | 208-455-6244
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Provider Business Mailing Address
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Address Line | 2020 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605-4343
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Country | US
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Telephone | 208-880-6127
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Fax | 208-455-6244
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Authorized Official
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Title or Position | OWNER COUNSELOR
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Name | MS. LYNDELL V. JACKSON
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Credential | LCPC
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Telephone | 208-880-6127
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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 | LCPC234
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License Number State | ID
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