Individual
ROBERTA CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LMFT, LCPC
Contact information
Practice address
1407 N 13TH ST, BOISE, ID 83702-3531
(208) 345-1022
(208) 433-1407
Mailing address
1407 N 13TH ST, BOISE, ID 83702-3531
(208) 345-1022
(208) 433-1407
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCPC-238
ID
106H00000X
Marriage & Family Therapist
Primary
LMFT-1
ID
Other
Enumeration date
10/15/2006
Last updated
11/19/2018
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