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General NPI Number Information
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NPI Number | 1508162512
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Entity Type | Organization
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Legal Business Name | MUSIC THERAPY OF IDAHO, LLC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 11210 W HICKORY LOOP DR
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City | BOISE
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State | ID
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Zip | 83713-1031
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Country | US
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Telephone | 208-371-9102
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Fax |
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Provider Business Mailing Address
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Address Line | 11210 W HICKORY LOOP DR
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City | BOISE
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State | ID
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Zip | 83713-1031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MUSIC THERAPIST
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Name | STEPHANIE LEAVELL
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Credential | MT-BC
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Telephone | 208-371-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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