Provider Demographics
NPI:1336425313
Name:FICA, ILA MARIE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ILA
Middle Name:MARIE
Last Name:FICA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:ILA
Other - Middle Name:MARIE
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4746
Mailing Address - Country:US
Mailing Address - Phone:208-221-6443
Mailing Address - Fax:
Practice Address - Street 1:303 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4746
Practice Address - Country:US
Practice Address - Phone:208-221-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4790101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor