Individual
MIRA LEE NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
420 W 4TH S, REXBURG, ID 83440-2319
(208) 656-4017
Mailing address
635 LINCOLN DR, IDAHO FALLS, ID 83401-4156
(530) 566-4117
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8241727
ID
Other
Enumeration date
02/06/2023
Last updated
12/10/2024
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