MEDICARE: CAITLIN A PARKER M.A., LCPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LCPC-4492	ID

General Provider Information

NPI Number	:	1114105194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN A PARKER M.A., LCPC, NCC

Provider Business Mailing Address
First Line	:	841 E FAIRVIEW AVE STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9386
Country	:	US
Telephone Number	:	208-695-7517
Fax Number	:	208-907-5229

Provider Business Practice Location Address
First Line	:	2584 N STOKESBERRY PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-1144
Country	:	US
Telephone Number	:	208-695-7517
Fax Number	:	208-288-5779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	08/25/2022

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