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General NPI Number Information
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NPI Number | 1720894231
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Entity Type | Organization
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Legal Business Name | BARK AND MOSS COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 6126 W STATE ST STE 202
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City | BOISE
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State | ID
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Zip | 83703-2741
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Country | US
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Telephone | 208-559-6011
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Fax | 986-236-4264
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Provider Business Mailing Address
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Address Line | 13601 W MCMILLAN RD # 102-104
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City | BOISE
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State | ID
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Zip | 83713-2025
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Country | US
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Telephone | 208-559-6011
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Fax | 986-236-4264
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Authorized Official
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Title or Position | DIRECTOR/PRINCIPAL
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Name | VALERIE ANNETTE LAMKE
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Credential | LMFT
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Telephone | 208-559-6011
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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