Individual
MS. LYNETTA RUTH HAGLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1277 E 17TH ST, IDAHO FALLS, ID 83404-6126
(208) 523-0787
(208) 523-3175
Mailing address
1277 E 17TH ST, IDAHO FALLS, ID 83404-6126
(208) 523-0787
(208) 523-3175
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW1367
ID
1041C0700X
Clinical Social Worker
LCSW1367
ID
Other
Enumeration date
04/10/2008
Last updated
04/10/2008
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