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NPI Code Detail

MEDICARE: NICHOLE MARIE SCHALLENBERGER LPC

MEDICARE: NICHOLE MARIE SCHALLENBERGER 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
1101YM0800XMental Health Counselor
2101YP2500XProfessional CounselorLPC-5799ID

General Provider Information

NPI Number : 1710378930
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE MARIE SCHALLENBERGER LPC
Provider Business Mailing Address
First Line : 5185 W OVERLAND RD
Second Line :
City : BOISE
State : ID
Zip : 83705-2635
Country : US
Telephone Number : 208-252-6174
Fax Number :
Provider Business Practice Location Address
First Line : 5185 W OVERLAND RD
Second Line :
City : BOISE
State : ID
Zip : 83705-2635
Country : US
Telephone Number : 208-252-6174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/28/2024

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