Individual
CHRISTA SANTOS-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
845 W CENTER ST, SUITE C, POCATELLO, ID 83204-4205
(208) 478-4642
(208) 232-8001
Mailing address
1012 HOMERUN ST, CHUBBUCK, ID 83202-1616
(208) 232-9430
(208) 232-8001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-860
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-960
BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
06/29/2011
Last updated
06/29/2011
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