MEDICARE: MRS. KAREN J CANFIELD 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
1	101YP2500X	Professional Counselor	LCPC-3319	ID

General Provider Information

NPI Number	:	1548258148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN J CANFIELD LCPC

Provider Business Mailing Address
First Line	:	4720 COLLISTER DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-3721
Country	:	US
Telephone Number	:	208-336-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 COLLISTER DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-3721
Country	:	US
Telephone Number	:	208-336-5720
Fax Number	:

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

Provider Enumeration Date	:	10/09/2005
Last Update Date	:	07/08/2007

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