Doctor Name: | MARCY J SPRAGUE |
NPI Number: | 1386986982 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC-3372 |
Business Practice Address: | 3522 Briar Creek Ln Ammon, ID - 834064728 |
Business Phone Number: | 2085291660 |
Business Fax Number: | 2085291699 |
Mailing Address: | 3522 Briar Creek Ln, Po Box 3858 AMMON |
State: | ID |
Postal Code: | 834064728 |
Phone Number: | 2085291660 |
Fax Number: | 2085291699 |
NPI Enumeration Date: | 03/21/2013 |
NPI Last Update Date: | 03/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC-3372 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |