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General NPI Number Information
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NPI Number | 1871318402
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Entity Type | Individual
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Provider Name | CARLY GAMANGASSO
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Gender | Female
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 16150 N HIGH DESERT ST STE 214
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City | NAMPA
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State | ID
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Zip | 83687-5566
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Country | US
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Telephone | 208-860-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 7295 BAY MEADOWS DR
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City | NAMPA
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State | ID
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Zip | 83687-8365
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | ID
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