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General NPI Number Information
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NPI Number | 1871089532
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Entity Type | Individual
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Provider Name | JAMES MHOON MS
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Gender | Male
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 2589 S FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83709-2325
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Country | US
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Telephone | 208-991-3165
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1411
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City | EAGLE
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State | ID
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Zip | 83616-9100
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Country | US
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Telephone | 206-794-8866
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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 | LPC6910
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LPC6910
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License Number State |
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