MEDICARE: STEPHEN CRANE

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	9481813	ID

General Provider Information

NPI Number	:	1245164128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN CRANE

Provider Business Mailing Address
First Line	:	2611 W LEMP ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-2349
Country	:	US
Telephone Number	:	208-996-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 E 41ST ST STE 2
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-6348
Country	:	US
Telephone Number	:	208-996-3650
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ STEPHEN CRANE ” Practice Location

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