=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508906108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY CELEST VOELLER M.ED.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 E COEUR DALENE AVE SUITE 2
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-664-1606
-----------------------------------------------------
Fax | 208-664-9685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1677
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83816-1677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-664-1606
-----------------------------------------------------
Fax | 208-664-9685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC 1034
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------