Individual
MYRNA SUE THATCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
976 HAAS RANCH RD, CRAIGMONT, ID 83523
(208) 962-7384
Mailing address
PO BOX 506, COTTONWOOD, ID 83522-0506
(208) 962-7384
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
LCMFT-053
KS
106H00000X
Marriage & Family Therapist
Primary
LMFT-2654
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010158872
REGENCE BLUE SHIELD
ID
Enumeration date
08/07/2007
Last updated
08/07/2007
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