Provider Demographics
NPI:1821681982
Name:NTAKARUTIMANA, ISSA (LCSW)
Entity type:Individual
Prefix:
First Name:ISSA
Middle Name:
Last Name:NTAKARUTIMANA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:NTAKAUTIMANA
Other - Middle Name:
Other - Last Name:ISSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 S BRUCE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7804
Mailing Address - Country:US
Mailing Address - Phone:208-906-5878
Mailing Address - Fax:
Practice Address - Street 1:500 W BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5916
Practice Address - Country:US
Practice Address - Phone:208-598-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical