Individual
MS. RANDI JO KORELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LCPC
Contact information
Practice address
113 N COMMERCIAL, EMMETT, ID 83617
(208) 398-8473
(208) 398-8311
Mailing address
2445 W HWY 52, EMMETT, ID 83617
(208) 365-5393
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
359
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152108
BLUE SHIELD
ID
01
—
Q7486
BLUE CROSS
ID
Enumeration date
02/28/2007
Last updated
07/08/2007
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