MEDICARE: AMY ABSALONSON LPC

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	6276	ID

General Provider Information

NPI Number	:	1346642105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ABSALONSON LPC

Provider Business Mailing Address
First Line	:	6428 W. INTERCHANGE LANE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709
Country	:	US
Telephone Number	:	208-502-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	6428 W. INTERCHANGE LANE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709
Country	:	US
Telephone Number	:	208-502-8126
Fax Number	:

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	07/24/2023

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