Provider Demographics
NPI:1780026369
Name:DOOMS, HANNAH ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:DOOMS
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 1:7229 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0909
Mailing Address - Country:US
Mailing Address - Phone:208-378-9636
Mailing Address - Fax:208-485-9826
Practice Address - Street 1:7229 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0909
Practice Address - Country:US
Practice Address - Phone:208-378-9636
Practice Address - Fax:208-485-9826
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1780026369Medicaid
ID1992035364Medicaid