Individual
KERI GLORIA LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1803 W GARWOOD RD, RATHDRUM, ID 83858-7108
(208) 209-2309
Mailing address
1803 W GARWOOD RD, RATHDRUM, ID 83858-7108
(208) 209-2309
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC 2913
ID
101YM0800X
Mental Health Counselor
LCPC 2913
ID
106H00000X
Marriage & Family Therapist
LCPC 2913
ID
Other
Enumeration date
04/18/2012
Last updated
04/18/2012
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