Individual
CATHY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
90 W JUDICIAL ST, BLACKFOOT, ID 83221-2715
(208) 782-2060
Mailing address
PO BOX 1294, 90 W JUDICIAL, BLACKFOOT, ID 83221-1294
(208) 782-2060
(208) 782-0209
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LCSW1058
ID
101YM0800X
Mental Health Counselor
LCSW1058
ID
101YP2500X
Professional Counselor
LCSW1058
ID
1041C0700X
Clinical Social Worker
Primary
LCSW1058
ID
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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