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Organization

MOUNTAIN LAUREL THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMANDA LYNN OVERACRE (MENTAL HEALTH THERAPIST)
(910) 308-6764
Entity
Organization

Contact information

Practice address
133 MAIN AVE W, SUITE 300, TWIN FALLS, ID 83301
(910) 308-6764
Mailing address
1011 BELL LN, KIMBERLY, ID 83341-5182
(910) 308-6764

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
06/04/2024
Last updated
06/04/2024
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