Organization
NORTHWEST PROFESSIONALS FAMILY RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONTY MOORE-JOHNSON LCPC (OWNER)
(208) 376-0979
Entity
Organization
Contact information
Practice address
6540 W EMERALD ST, SUITE 100, BOISE, ID 83704-8782
(208) 376-0979
(208) 378-1089
Mailing address
PO BOX 44689, BOISE, ID 83711-0689
(208) 376-0979
(208) 378-1089
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8L105
BLUE CROSS OF IDAHO
ID
Enumeration date
04/10/2007
Last updated
08/22/2020
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