Individual
GAIL INGRA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, LCPC
Contact information
Practice address
320 11TH AVE S STE 204, NAMPA, ID 83651-5074
(208) 871-7040
(208) 908-6164
Mailing address
320 11TH AVE S STE 204, NAMPA, ID 83651-5074
(208) 871-7040
(208) 908-6164
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCPC-6750
ID
101YP2500X
Professional Counselor
Primary
LPC-5336
ID
Other
Enumeration date
10/16/2013
Last updated
01/12/2021
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