| NPI | 1386768943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL ANGELA KELLICUT Counselor Coowner 208-667-8474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC 137) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH00003616) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW 179) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00004911) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT 3069) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF00000961) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT 3089) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF00001127) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |