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General NPI Number Information
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NPI Number | 1871044776
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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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 | 208-870-5022
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Fax |
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Provider Business Mailing 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 | 208-870-5022
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. AMY MAREE DAVIS
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Credential | LCPC
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Telephone | 208-870-5022
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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 | LCPC-5417
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License Number State | ID
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