Individual
MISS CASSANDRE LYNN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
671 E RIVERPARK LN STE 100, BOISE, ID 83706-4000
(208) 861-7448
Mailing address
999 N SLATER CRK, BOISE, ID 83716-5015
(208) 861-7448
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCSW-36307
ID
101YM0800X
Mental Health Counselor
Primary
LCSW-36307
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-36307
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
12/20/2012
Last updated
09/21/2020
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