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General NPI Number Information
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NPI Number | 1477917722
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Entity Type | Organization
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Legal Business Name | DIANE BARNHILL SUNTIGER ENTERPRISES
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 1001 N 27TH ST INFINITY AND WELLNESS CENTER
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City | BOISE
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State | ID
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Zip | 83702-2202
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Country | US
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Telephone | 208-602-8867
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Fax | 208-378-7686
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Provider Business Mailing Address
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Address Line | 2010 N FRY ST
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City | BOISE
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State | ID
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Zip | 83704-7619
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Country | US
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Telephone | 208-602-8867
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Fax | 208-378-7686
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Authorized Official
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Title or Position | COUNSELOR
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Name | DIANE OF BARNHILL
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Credential | PSY.D., LCPC
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Telephone | 208-602-8867
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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 | LCPC-11
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License Number State | ID
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