Doctor Name: | LISA A FOODIM |
NPI Number: | 1619968500 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | LCSW-852 |
Business Practice Address: | 6635 Comanche St Bonners Ferry, ID - 838057523 |
Business Phone Number: | 2082671718 |
Business Fax Number: | 2082677739 |
Mailing Address: | 6635 Comanche St, BONNERS FERRY |
State: | ID |
Postal Code: | 838057523 |
Phone Number: | 2082671718 |
Fax Number: | 2082677739 |
NPI Enumeration Date: | 10/31/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCSW-852 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |