Individual
HEIDI ALYSSA STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4024 IVY DR, NAMPA, ID 83686-8852
(208) 890-3864
Mailing address
4024 IVY DR, NAMPA, ID 83686-8852
(208) 890-3864
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMSW-38223
ID
106H00000X
Marriage & Family Therapist
—
ID
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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