Individual
KRYSTALROSE WORTHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406
(208) 346-7500
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 821-8688
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-7195
ID
Other
Enumeration date
02/06/2011
Last updated
02/14/2019
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