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General NPI Number Information
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NPI Number | 1912230202
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Entity Type | Organization
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Legal Business Name | EGO MATTERS COUNSELING & MEDIATION
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 601 E FRONT AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2701
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Country | US
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Telephone | 425-223-2828
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Fax | 208-262-9288
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Provider Business Mailing Address
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Address Line | 601 E FRONT AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2701
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Country | US
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Telephone | 425-223-2828
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Fax | 208-262-9288
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Authorized Official
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Title or Position | OWNER
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Name | JEAN ANN GABBY
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Credential | MS, LPC, NCC
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Telephone | 425-223-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-4373
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License Number State | ID
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