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General NPI Number Information
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NPI Number | 1669825451
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Entity Type | Individual
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Provider Name | VANESSA MATOSSIAN M.S., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 317 W 6TH ST STE 208
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City | MOSCOW
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State | ID
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Zip | 83843-2387
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Country | US
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Telephone | 208-882-3504
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Fax | 208-882-3572
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Provider Business Mailing Address
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Address Line | 320 N GARFIELD ST
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City | MOSCOW
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State | ID
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Zip | 83843-3666
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Country | US
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Telephone | 208-596-9971
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-6260
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License Number State | ID
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