Provider Demographics
NPI:1205347408
Name:YAGANEH, NATASHA RENEA (LPC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENEA
Last Name:YAGANEH
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:PO BOX 9153
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-3153
Mailing Address - Country:US
Mailing Address - Phone:503-475-7505
Mailing Address - Fax:
Practice Address - Street 1:7192 W POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9147
Practice Address - Country:US
Practice Address - Phone:833-527-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health