Provider Demographics
NPI:1699806745
Name:TITHERLEY, JANICE LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LEE
Last Name:TITHERLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N LAKEWOOD DR STE 222
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2473
Mailing Address - Country:US
Mailing Address - Phone:208-274-3320
Mailing Address - Fax:
Practice Address - Street 1:RADIANT CHRISTIAN COUNSELING
Practice Address - Street 2:2101 N LAKEWOOD DRIVE, SUITE 222
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-274-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32486106H00000X
IDLMFT-7611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32486OtherLMFT
IDLMFT-7611OtherLMFT