Provider Demographics
NPI:1710367529
Name:GUASPARI, SALLY (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:GUASPARI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 N LIVERPOOL AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5428
Mailing Address - Country:US
Mailing Address - Phone:208-805-2034
Mailing Address - Fax:888-512-7090
Practice Address - Street 1:688 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5458
Practice Address - Country:US
Practice Address - Phone:208-805-2034
Practice Address - Fax:888-512-7090
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-06
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional