Provider Demographics
NPI:1093499352
Name:EAGER, MATALYNN BELLE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:MATALYNN
Middle Name:BELLE
Last Name:EAGER
Suffix:
Gender:F
Credentials:LPC
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 STE 260
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5976
Mailing Address - Country:US
Mailing Address - Phone:208-888-5905
Mailing Address - Fax:208-888-5513
Practice Address - Street 1:2995 N COLE RD STE 260
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5976
Practice Address - Country:US
Practice Address - Phone:208-888-5905
Practice Address - Fax:208-888-5513
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health