Provider Demographics
NPI:1790185031
Name:ALVAREZ, STEPHANIE (LAMFT, LPC, MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LAMFT, LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 E SNOWY OWL ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3411
Mailing Address - Country:US
Mailing Address - Phone:208-371-3306
Mailing Address - Fax:855-854-9078
Practice Address - Street 1:4444 W TAFT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4148
Practice Address - Country:US
Practice Address - Phone:208-501-2181
Practice Address - Fax:855-854-9078
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5578101YP2500X
IDLAMFT-5535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional