Provider Demographics
NPI:1508267469
Name:ALBRECHT, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2171
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-2171
Mailing Address - Country:US
Mailing Address - Phone:208-309-2717
Mailing Address - Fax:
Practice Address - Street 1:100 GOLDEN EAGLE DR S
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-5129
Practice Address - Country:US
Practice Address - Phone:208-309-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional