Organization
FLOW STATE PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA MISSAL LCPC (OWNER/PROVIDER)
(406) 546-2025
Entity
Organization
Contact information
Practice address
613 N RIVER ST STE 1A, HAILEY, ID 83333-8438
(406) 546-2025
Mailing address
PO BOX 5895, HAILEY, ID 83333-5895
(406) 546-2025
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083959332
—
ID
Enumeration date
03/17/2021
Last updated
03/17/2021
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