Individual
ELIZABETH MATHES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 N 7TH ST STE C4, COEUR D ALENE, ID 83814-2736
(208) 676-8884
Mailing address
1006 E LAKESIDE AVE, COEUR D ALENE, ID 83814-4137
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC 200
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q4590
BLUE CROSS OF IDAHO
ID
Enumeration date
03/26/2007
Last updated
07/09/2007
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