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NPI Code Detail

MEDICARE: KAREN S. MCCONAUGHEY LCPC

MEDICARE: KAREN S. MCCONAUGHEY 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
1101Y00000XCounselorLCPC 295ID

General Provider Information

NPI Number : 1639188907
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN S. MCCONAUGHEY LCPC
Provider Business Mailing Address
First Line : 6003 W OVERLAND RD STE 105
Second Line :
City : BOISE
State : ID
Zip : 83709-3075
Country : US
Telephone Number : 208-321-1212
Fax Number : 208-345-2077
Provider Business Practice Location Address
First Line : 6003 W OVERLAND RD STE 105
Second Line :
City : BOISE
State : ID
Zip : 83709-3075
Country : US
Telephone Number : 208-321-1212
Fax Number : 208-345-2077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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