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General NPI Number Information
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NPI Number | 1790675049
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Entity Type | Individual
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Provider Name | ISABELLA RAQUEL ANDERSON LPC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1335 S 5TH AVE APT 108
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City | POCATELLO
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State | ID
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Zip | 83201-6709
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Country | US
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Telephone | 505-363-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 3852 N EAGLE RD
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City | BOISE
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State | ID
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Zip | 83713-0750
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Country | US
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Telephone | 208-378-0014
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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 | 3571869
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License Number State | ID
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