MEDICARE: NASEEM KHERICHA

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	101YM0800X	Mental Health Counselor	LCPC	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCPC	OTHER	ID	IDOL

General Provider Information

NPI Number	:	1154519619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASEEM KHERICHA

Provider Business Mailing Address
First Line	:	PO BOX 4285
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83205-4285
Country	:	US
Telephone Number	:	208-552-0850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 JENNIE LEE DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6159
Country	:	US
Telephone Number	:	208-974-5200
Fax Number	:

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	07/26/2024

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Directions to “ NASEEM KHERICHA ” Practice Location

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