Provider Demographics
NPI:1558685305
Name:NORELL, RAE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RAE
Middle Name:ANN
Last Name:NORELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 S. VISTA AVE
Mailing Address - Street 2:#190
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-343-2737
Mailing Address - Fax:208-342-3238
Practice Address - Street 1:2273 S. VISTA AVE
Practice Address - Street 2:#190 TREASURE VALLEY COMMUNITY COUNSELING SERVICES
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-343-2737
Practice Address - Fax:208-342-3238
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-6671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical