Organization
STATE AVENUE OFFICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLA J CAFFERTY LCPC (OWNER)
(208) 994-3599
Entity
Organization
Contact information
Practice address
39 E STATE AVE, MERIDIAN, ID 83642-2342
(208) 994-3599
(208) 473-2206
Mailing address
39 E STATE AVE, MERIDIAN, ID 83642-2342
(208) 994-3599
(208) 473-2206
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/02/2012
Last updated
10/09/2012
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