Individual
CAROL PANGBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3042 S WHITEPOST WAY, EAGLE, ID 83616-6461
(208) 939-7514
Mailing address
3042 S WHITEPOST WAY, EAGLE, ID 83616-6461
(208) 939-7514
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC 168
ID
Other
Enumeration date
02/12/2007
Last updated
01/13/2008
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