Individual
GINA H JUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
819 N 12TH AVE, POCATELLO, ID 83201-4741
(203) 232-2263
Mailing address
819 N 12TH AVE, POCATELLO, ID 83201-4741
(203) 232-2263
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-4357
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC-4357
ID
101YM0800X
Mental Health Counselor
Primary
LPC-4357
ID
Other
Enumeration date
01/06/2010
Last updated
01/06/2010
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