Provider Demographics
NPI:1033599568
Name:OSS, MARSHA JT (CADC, CDC II, BHC II)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:JT
Last Name:OSS
Suffix:
Gender:F
Credentials:CADC, CDC II, BHC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5964
Mailing Address - Country:US
Mailing Address - Phone:208-287-3285
Mailing Address - Fax:208-995-2896
Practice Address - Street 1:2995 N COLE RD
Practice Address - Street 2:SUITE 255
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5964
Practice Address - Country:US
Practice Address - Phone:208-287-3285
Practice Address - Fax:208-995-2896
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1122006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1518357649Medicaid