Provider Demographics
NPI:1235533175
Name:DEMERS, MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DEMERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 N SEVENOAKS AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7308
Mailing Address - Country:US
Mailing Address - Phone:208-519-8355
Mailing Address - Fax:
Practice Address - Street 1:1045 S ANCONA AVE STE 140
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6374
Practice Address - Country:US
Practice Address - Phone:208-352-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor