Individual
MADELINE ROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LMT
Contact information
Practice address
913 S LATAH ST STE A, BOISE, ID 83705-2265
(208) 402-8713
(210) 255-2135
Mailing address
913 S LATAH ST STE A, BOISE, ID 83705-2265
(208) 402-8713
(208) 460-4394
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8158
ID
101YM0800X
Mental Health Counselor
Primary
LCPC-9511
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9511
IDAHO BOARD OF COUNSELORS
ID
01
—
LPC-8158
IDAHO BOARD OF COUNSELORS
ID
Enumeration date
10/24/2017
Last updated
02/07/2025
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