Individual
AVALON NOEL TAYLOR DERLACKI PRENTISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1015 W HAYS ST STE 102, BOISE, ID 83702-5412
(208) 207-8889
Mailing address
1015 W HAYS ST STE 102, BOISE, ID 83702-5412
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8188
ID
Other
Enumeration date
07/19/2021
Last updated
11/19/2024
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