Individual
MS. LYDIA JO MISSAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
613 N RIVER ST STE 1A, HAILEY, ID 83333-8438
(406) 546-2025
Mailing address
PO BOX 5895, HAILEY, ID 83333-5895
(406) 546-2025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-5912
ID
101YP2500X
Professional Counselor
2407
MT
101YP2500X
Professional Counselor
Primary
LCPC-5876
ID
Other
Enumeration date
11/27/2012
Last updated
03/17/2021
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