Provider Demographics
NPI:1497485056
Name:RAMIREZ, PETRA (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5478
Mailing Address - Country:US
Mailing Address - Phone:986-895-3377
Mailing Address - Fax:
Practice Address - Street 1:524 CLEVELAND BLVD STE 205
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4080
Practice Address - Country:US
Practice Address - Phone:208-606-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor