Provider Demographics
NPI:1679909329
Name:NINA, ANILE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANILE
Middle Name:
Last Name:NINA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5484 N GARY LANE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714
Mailing Address - Country:US
Mailing Address - Phone:208-371-6702
Mailing Address - Fax:208-501-8548
Practice Address - Street 1:5484 N GARY LANE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:208-371-6702
Practice Address - Fax:208-501-8548
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5185101YP2500X
IDLCPC-6859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional