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Organization
SERENITY LIGHTHOUSE COUNSELING
Active
Organization
SERENITY LIGHTHOUSE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATY SIMMONS (BILLING/CREDENTIALING)
(208) 452-6580
Entity
Organization
Contact information
Practice address
2498 N STOKESBERRY PL STE 100, MERIDIAN, ID 83646-5842
(208) 939-6267
Mailing address
2498 N STOKESBERRY PLACE #100, MERIDIAN, ID 83646
(208) 939-6267
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4565
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922346576
—
ID
Enumeration date
03/14/2016
Last updated
03/14/2016
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