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General NPI Number Information
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NPI Number | 1841671971
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Entity Type | Individual
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Provider Name | LUIS JAVIER CORTEZ II LPC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 750 W USTICK RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83646-6133
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Country | US
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Telephone | 208-697-7116
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Fax |
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Provider Business Mailing Address
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Address Line | 4465 N WESTON AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-3945
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Country | US
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Telephone | 208-697-7116
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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-5905
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License Number State | ID
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