Provider Demographics
NPI:1437635802
Name:CARTER, SAVANNAH VLASSEK (LPC)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:VLASSEK
Last Name:CARTER
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 1:1406 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1746
Mailing Address - Country:US
Mailing Address - Phone:435-229-7435
Mailing Address - Fax:
Practice Address - Street 1:1406 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1746
Practice Address - Country:US
Practice Address - Phone:435-229-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health