Organization
SECOND WIND COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LONNA MAHANA (PROVIDER RELATIONS)
(208) 287-9420
Entity
Organization
Contact information
Practice address
1423 W FRANKLIN ST, BOISE, ID 83702-5024
(208) 345-2212
(208) 345-2282
Mailing address
7621 W WAVERLY DR, BOISE, ID 83704-7210
(208) 287-9420
(208) 287-9426
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-3442
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC-3442
STATE LICENSE
ID
Enumeration date
03/08/2017
Last updated
03/08/2017
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