Individual
ILA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
60 N BROADWAY ST, BLACKFOOT, ID 83221-2706
(208) 782-3434
Mailing address
60 N BROADWAY ST, BLACKFOOT, ID 83221-2706
(208) 782-3434
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-9328
ID
Other
Enumeration date
02/15/2023
Last updated
02/15/2023
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