MEDICARE: AVONLEY WHITSITT LAMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1225763188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVONLEY WHITSITT LAMFT

Provider Business Mailing Address
First Line	:	9169 W STATE ST # 447
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-1733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9169 W STATE ST # 447
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-1733
Country	:	US
Telephone Number	:	208-917-3302
Fax Number	:

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

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/19/2024

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Directions to “ AVONLEY WHITSITT LAMFT” Practice Location

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