=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831555325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RITA FELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2016
-----------------------------------------------------
Last Update Date | 01/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 923 GRANT ST
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83605-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-585-3375
-----------------------------------------------------
Fax | 208-585-6152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7620 N APACHE WAY CIR
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83714-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-585-3375
-----------------------------------------------------
Fax | 208-585-6152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC-977
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------