Individual
NICOLE KONEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S ALMON ST, SUITE #204, MOSCOW, ID 83843-2098
(208) 310-4578
Mailing address
200 S ALMON ST, SUITE #204, MOSCOW, ID 83843-2098
(208) 310-4578
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC946
ID
Other
Enumeration date
04/01/2011
Last updated
09/09/2011
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