Doctor Name: | MS. CHRYSTAL MARIE HODGSON |
NPI Number: | 1477877579 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | LMSW 26449 |
Business Practice Address: | 89 Homer Dr St Maries, ID - 838615078 |
Business Phone Number: | 2082455427 |
Business Fax Number: | |
Mailing Address: | 260 Whitetail Draw Rd, ST MARIES |
State: | ID |
Postal Code: | 838619747 |
Phone Number: | 2086995982 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2010 |
NPI Last Update Date: | 03/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LMSW 26449 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |