Individual
ANNIE MIKESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LCPC
Contact information
Practice address
410 S ORCHARD ST STE 124, BOISE, ID 83705-1210
(208) 146-0719
Mailing address
PO BOX 8413, BOISE, ID 83707-2413
(208) 614-0719
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC7432
ID
101YP2500X
Professional Counselor
LPC-6341
ID
Other
Enumeration date
07/10/2017
Last updated
07/18/2023
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