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General NPI Number Information
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NPI Number | 1588219497
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Entity Type | Individual
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Provider Name | ELIZABETH MACKLIN LPC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 444 HOSPITAL WAY STE 477
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City | POCATELLO
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State | ID
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Zip | 83201-2744
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Country | US
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Telephone | 208-233-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 1373 JENSEN ST
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City | POCATELLO
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State | ID
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Zip | 83201-6019
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Country | US
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Telephone | 208-406-4235
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-7354
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License Number State | ID
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