1174816680 NPI number — MRS. KRISTINE ANN KIRSCH MCOUN., LPC

Table of content: MRS. KRISTINE ANN KIRSCH MCOUN., LPC (NPI 1174816680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174816680 NPI number — MRS. KRISTINE ANN KIRSCH MCOUN., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRSCH
Provider First Name:
KRISTINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MCOUN., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174816680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 S CANVASBACK WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-3715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-830-8658
Provider Business Mailing Address Fax Number:
208-342-7030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 W AMERICANA TER
Provider Second Line Business Practice Location Address:
SUITE #215
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-830-8658
Provider Business Practice Location Address Fax Number:
208-342-0667
Provider Enumeration Date:
05/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC-4044 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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