Individual
MONTY L MOORE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
6540 W EMERALD ST, SUITE 100, BOISE, ID 83704-8782
(208) 376-0979
(208) 378-1089
Mailing address
PO BOX 44689, BOISE, ID 83711-0689
(208) 376-0979
(208) 378-1089
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-209
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145850
REGENCE BLUE SHIELD OF ID
ID
01
—
Q6371
BLUE CROSS OF IDAHO
ID
Enumeration date
02/14/2007
Last updated
07/08/2007
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