Individual
LISA ANNE PERUCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
Mailing address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
40790
ID
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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