1629280250 NPI number — SEREN MORRIS CLANCY LCPC, LPCC, LPAT

Table of content: SEREN MORRIS CLANCY LCPC, LPCC, LPAT (NPI 1629280250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629280250 NPI number — SEREN MORRIS CLANCY LCPC, LPCC, LPAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLANCY
Provider First Name:
SEREN
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC, LPCC, LPAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRIS
Provider Other First Name:
LINNEA
Provider Other Middle Name:
SERENDEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629280250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1423 W FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83702-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-345-2212
Provider Business Mailing Address Fax Number:
208-345-2282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-345-2212
Provider Business Practice Location Address Fax Number:
208-345-2282
Provider Enumeration Date:
05/04/2007

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: 101YP2500X , with the licence number:  LCPC-5108 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 0122221 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com