Organization
MOUNTAIN LAKE COUNSELING AND SUPPORT SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M. MIKELL ZIMMERMAN (PRESIDENT)
(208) 597-3553
Entity
Organization
Contact information
Practice address
804 AIRPORT WAY, SANDPOINT, ID 83864-8200
(208) 597-3553
Mailing address
804 AIRPORT WAY, SANDPOINT, ID 83864-8200
(208) 597-3553
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC-3664
ID
251S00000X
Community/Behavioral Health Agency
Primary
LPC-3664
ID
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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