Provider Demographics
NPI:1689656308
Name:TOWLE, TERRIE J (LCPC)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:J
Last Name:TOWLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 N WESTGATE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7174
Mailing Address - Country:US
Mailing Address - Phone:208-373-0790
Mailing Address - Fax:208-373-0816
Practice Address - Street 1:3306 N ACRE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4503
Practice Address - Country:US
Practice Address - Phone:208-344-7800
Practice Address - Fax:208-373-0816
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010017059OtherREGENCE BLUE SHIELD OF IDAHO
IDQ7652OtherBLUE CROSS OF IDAHO