Individual
CRYSTAL ANGEL LISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8738
Mailing address
1532 CANYON RD S, MELBA, ID 83641-5271
(208) 484-1374
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW-33082
ID
101YM0800X
Mental Health Counselor
LMSW-30593
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-33082
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
850370802
—
ID
Enumeration date
03/18/2011
Last updated
11/26/2019
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