Individual
KATIE MARIE VAN TASSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2114 S ROOSEVELT ST, BOISE, ID 83705-3201
(571) 606-0792
Mailing address
2114 S ROOSEVELT ST, BOISE, ID 83705-3201
(571) 606-0792
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-5599
ID
Other
Enumeration date
03/23/2015
Last updated
03/23/2015
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