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Organization
PEREGRINE CORP, PC
Active
Organization
PEREGRINE CORP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORLEA ANN KNIZLEY LPC (BOARD PRESIDENT)
(208) 448-4855
Entity
Organization
Contact information
Practice address
37 HIGHWAY 57, PRIEST RIVER, ID 83856-6559
(208) 448-4855
(208) 448-2467
Mailing address
PO BOX 205, PRIEST RIVER, ID 83856-0205
(208) 448-4855
(208) 448-2467
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC - 139
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016976
REGENCE BLUESHIELD
—
05
—
807348800
—
ID
05
—
807375500
—
ID
01
—
Q2776
BLUE CROSS OF IDAHO
—
Enumeration date
10/09/2009
Last updated
09/25/2013
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