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NPI Code Detail

MEDICARE: MRS. BETTY J MAGNUS LCPC

MEDICARE:  MRS. BETTY J MAGNUS  LCPC
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
1101YP2500XProfessional Counselor2910ID

General Provider Information

NPI Number : 1457667545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETTY J MAGNUS LCPC
Provider Business Mailing Address
First Line : 15798 N RIMROCK RD
Second Line :
City : HAYDEN LAKE
State : ID
Zip : 83835-7336
Country : US
Telephone Number : 208-772-5360
Fax Number :
Provider Business Practice Location Address
First Line : 15798 N RIMROCK RD
Second Line :
City : HAYDEN LAKE
State : ID
Zip : 83835-7336
Country : US
Telephone Number : 208-772-5360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2010
Last Update Date : 08/26/2010

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Directions to “ MRS. BETTY J MAGNUS LCPC” Practice Location

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