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Organization

SERENITY LIGHTHOUSE COUNSELING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATY SIMMONS (BILLING/CREDENTIALING)
(208) 452-6580
Entity
Organization

Contact information

Practice address
2498 N STOKESBERRY PL STE 100, MERIDIAN, ID 83646-5842
(208) 939-6267
Mailing address
2498 N STOKESBERRY PLACE #100, MERIDIAN, ID 83646
(208) 939-6267

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4565
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1922346576
ID
Enumeration date
03/14/2016
Last updated
03/14/2016
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