Doctor Name: | MR. CHARLES BENTON MCCONNELL |
NPI Number: | 1104932383 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | LPCP 127 |
Business Practice Address: | 413 N Allumbaugh Suite 103 Boise, ID - 83704 |
Business Phone Number: | 2086580800 |
Business Fax Number: | 2083231894 |
Mailing Address: | 413 N Allumbaugh, Suite 103 BOISE |
State: | ID |
Postal Code: | 83704 |
Phone Number: | 2086580800 |
Fax Number: | 2083231894 |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LPCP 127 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |