Provider Demographics
NPI:1518116383
Name:CURTIS, CHARLENE CARYL (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:CARYL
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 W. KING ST.
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-345-2950
Mailing Address - Fax:208-323-1868
Practice Address - Street 1:7950 W. KING ST.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-342-2950
Practice Address - Fax:208-323-1868
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional