Individual
NADAMAYI SHANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1498 E HOLLY ST, BOISE, ID 83712-8309
(208) 615-8755
Mailing address
1498 E HOLLY ST, BOISE, ID 83712-8309
(208) 615-8755
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8300
ID
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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