| Doctor Name: | CHRISTA STALLWORTH |
| NPI Number: | 1023412202 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 5664 |
| Business Practice Address: | 847 Parkcentre Way #4 Nampa, ID - 836511792 |
| Business Phone Number: | 2084672673 |
| Business Fax Number: | |
| Mailing Address: | Po Box 15914, BOISE |
| State: | ID |
| Postal Code: | 837155914 |
| Phone Number: | 5802845338 |
| Fax Number: | |
| NPI Enumeration Date: | 10/16/2014 |
| NPI Last Update Date: | 10/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 5664 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |