Provider Demographics
NPI:1245225879
Name:LUQUE, ROSEMARY LADACY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:LADACY
Last Name:LUQUE
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 1:4172 N CRESWELL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2403
Mailing Address - Country:US
Mailing Address - Phone:208-863-1404
Mailing Address - Fax:833-340-7217
Practice Address - Street 1:4172 N CRESWELL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2403
Practice Address - Country:US
Practice Address - Phone:208-863-1404
Practice Address - Fax:833-340-7217
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2773101YM0800X
IDLCPC3480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010140465OtherREGENCE BLUESHIELD ID #
ID200000062851OtherBLUE CROSS OF IDAHO
ID7365212Medicaid