Provider Demographics
NPI:1336874445
Name:SOMES, STACI ROCK (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:ROCK
Last Name:SOMES
Suffix:
Gender:F
Credentials:LPC, NCC
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 191097
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1097
Mailing Address - Country:US
Mailing Address - Phone:208-607-3639
Mailing Address - Fax:
Practice Address - Street 1:4337 S MAESAIA WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9084
Practice Address - Country:US
Practice Address - Phone:208-607-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC8965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health