Individual
CARMEN STITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 522-0140
(208) 524-7335
Mailing address
1675 CURLEW DR, AMMON, ID 83406-4850
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-6628
ID
Other
Enumeration date
07/28/2017
Last updated
11/30/2023
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