Provider Demographics
NPI:1710081765
Name:KIRCHER, MARK L (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:KIRCHER
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 1:3350 AMERICANA TER STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2548
Mailing Address - Country:US
Mailing Address - Phone:208-343-1113
Mailing Address - Fax:208-343-0040
Practice Address - Street 1:3350 AMERICANA TER STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-343-1113
Practice Address - Fax:208-343-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC #9101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLSWOtherLICENSED SOCIAL WORKER