Individual
DESTINEE JO BLAMIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
540 S 16TH ST STE 118, PAYETTE, ID 83661-3514
(208) 546-2406
Mailing address
5176 CALEB CT, FRUITLAND, ID 83619-3816
(208) 546-2406
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-6728
ID
101YM0800X
Mental Health Counselor
LPC-6728
ID
Other
Enumeration date
03/28/2018
Last updated
03/28/2018
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