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General NPI Number Information
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NPI Number | 1619791183
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Entity Type | Individual
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Provider Name | EMILY MOORHEAD
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1276 W RIVER ST STE 100
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City | BOISE
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State | ID
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Zip | 83702-7083
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Country | US
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Telephone | 208-338-4699
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Fax | 208-322-4722
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Provider Business Mailing Address
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Address Line | 3324 N LAKEHARBOR LN # G-203
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City | BOISE
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State | ID
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Zip | 83703-6255
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Country | US
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Telephone | 907-441-6373
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4761577
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License Number State | ID
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