Organization
CRESWELL COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY LADACY LUQUE LCPC (BUSINESS OWNER/PROVIDER)
(208) 863-1404
Entity
Organization
Contact information
Practice address
4172 N CRESWELL WAY, BOISE, ID 83713-2403
(208) 863-1404
(833) 340-7217
Mailing address
4172 N CRESWELL WAY, BOISE, ID 83713-2403
(208) 863-1404
(833) 340-7217
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000014376
BLUE CROSS OF IDAHO
ID
05
—
7365212
—
ID
Enumeration date
01/18/2024
Last updated
02/02/2024
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