Provider Demographics
NPI:1003101189
Name:PICKEREL, ROXANNE L (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:L
Last Name:PICKEREL
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4528
Mailing Address - Country:US
Mailing Address - Phone:208-841-8109
Mailing Address - Fax:208-203-1879
Practice Address - Street 1:203 W FORT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4528
Practice Address - Country:US
Practice Address - Phone:208-841-8109
Practice Address - Fax:208-203-1879
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC4245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health