Individual
LEA SERRANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
575 E PARKCENTER BLVD, BOISE, ID 83706-6674
(208) 731-6549
Mailing address
6360 S MANGROVE PL, BOISE, ID 83716-7107
(208) 731-6549
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC6508
ID
101YP2500X
Professional Counselor
Primary
LCPC7489
ID
Other
Enumeration date
06/29/2017
Last updated
04/29/2024
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