Individual
KACEE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
28371 EL PASO RD, CALDWELL, ID 83607-7521
(208) 454-8847
Mailing address
5040 FREEMONT RD, NEW PLYMOUTH, ID 83655-5425
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC7175
ID
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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