Individual
MALYA BINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
486 WEST 1ST AVE, GLENNS FERRY, ID 83623-0266
(208) 366-7416
(208) 366-2595
Mailing address
360 W MADISON AVE, GLENNS FERRY, ID 83623-2364
(208) 366-2185
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-3498
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010156752
BLUESHIELD OF IDAHO #
ID
01
—
LPC-3498
IDAHO LICENSE #
ID
01
—
X6899
BLUE CROSS OF IDAHO #
ID
Enumeration date
03/06/2007
Last updated
07/08/2007
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