Provider Demographics
NPI:1346648417
Name:DAHLIN, MERIDITH ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MERIDITH
Middle Name:ANN
Last Name:DAHLIN
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 1:1655 W FAIRVIEW AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5120
Mailing Address - Country:US
Mailing Address - Phone:208-515-7661
Mailing Address - Fax:
Practice Address - Street 1:1655 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5120
Practice Address - Country:US
Practice Address - Phone:208-515-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2933101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool