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General NPI Number Information
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NPI Number | 1982238606
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Entity Type | Individual
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Provider Name | LESLIE MAGGARD LPC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 314 BADIOLA ST
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City | CALDWELL
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State | ID
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Zip | 83605-4389
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Country | US
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Telephone | 208-454-8389
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Fax | 208-454-8404
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Provider Business Mailing Address
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Address Line | 1607 CHECOLA ST APT A
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City | NAMPA
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State | ID
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Zip | 83686-7627
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Country | US
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Telephone | 208-965-4774
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-7315
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License Number State | ID
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