Provider Demographics
NPI:1124376470
Name:NOLEEN, ALISA J (LCPC)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:J
Last Name:NOLEEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2635
Mailing Address - Country:US
Mailing Address - Phone:208-391-3168
Mailing Address - Fax:208-342-7584
Practice Address - Street 1:5185 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2635
Practice Address - Country:US
Practice Address - Phone:208-391-3168
Practice Address - Fax:208-342-7584
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5046101YM0800X
IDLCPC-6125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health