Organization
POWDER BASIN ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN A MOORE CPC (OWNER PRESIDENT)
(208) 209-0535
Entity
Organization
Contact information
Practice address
204 OREGON ST, KELLOGG, ID 83837-5008
(208) 783-0427
(208) 783-1387
Mailing address
7905 N MEADOWLARK WAY, SUITE E, COEUR D ALENE, ID 83815-5041
(208) 209-0535
(208) 209-0966
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807277200
—
ID
Enumeration date
05/19/2008
Last updated
05/19/2008
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