Individual
MS. GINA WOLFE SEYBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED CLINICAL PR
Contact information
Practice address
1408 W HAYS ST, BOISE, ID 83702
(208) 387-0778
(208) 336-7125
Mailing address
1408 W HAYS ST, BOISE, ID 83702
(208) 387-0778
(208) 336-7125
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC122
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017707
REGENCE BLUE SHIELD
ID
01
—
Q6983
BLUE CROSS OF ID
ID
Enumeration date
09/17/2006
Last updated
07/08/2007
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