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General NPI Number Information
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NPI Number | 1801100847
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Entity Type | Individual
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Provider Name | CRISTI I. DAME LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 1524 WEST HAYS STREET SUITE 102
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-477-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 E. SADIE DR.
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-477-1044
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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-4349
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License Number State | ID
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