Individual
IDA MAE BOATMAN-GOUSSIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1413 RUSSELL AVE, JEFFERSON CITY, TN 37760-2562
(865) 471-5525
Mailing address
PO BOX 577, NEWPORT, TN 37822-0577
(423) 613-3300
(423) 623-4088
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2267
TN
101YP2500X
Professional Counselor
LPC013160
GA
Other
Enumeration date
07/23/2008
Last updated
01/02/2025
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