=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588704563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH MCCARRON M.A., L.M.F.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2448 N MERRIT CREEK LOOP
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-4953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-661-0584
-----------------------------------------------------
Fax | 208-773-6896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6203 N LA ROCHELLE DR
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-9799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-661-0584
-----------------------------------------------------
Fax | 208-773-6896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT-3024
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------