Individual
MRS. POLLY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4948 W KOOTENAI ST STE 201, BOISE, ID 83705-2082
(208) 810-0523
Mailing address
4948 W KOOTENAI ST STE 201, BOISE, ID 83705-2082
(208) 810-0523
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-7723
ID
Other
Enumeration date
06/13/2021
Last updated
08/07/2023
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