MEDICARE: INNER BALANCE COUNSELING LLC

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	LPC-4628	ID

General Provider Information

NPI Number	:	1215222138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER BALANCE COUNSELING LLC

Provider Business Mailing Address
First Line	:	216 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-965-8180
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-965-8180
Fax Number	:

Authorized Official
Title or Position	:	LLC MANAGER, PROFESSIONAL COUNSELOR
Name	:	MR. JOESPH A. BUGHER
Credential	:	LPC
Telephone Number	:	208-965-8180

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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