Provider Demographics
NPI:1912230202
Name:EGO MATTERS COUNSELING & MEDIATION
Entity Type:Organization
Organization Name:EGO MATTERS COUNSELING & MEDIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GABBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:425-223-2828
Mailing Address - Street 1:601 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2701
Mailing Address - Country:US
Mailing Address - Phone:425-223-2828
Mailing Address - Fax:208-262-9288
Practice Address - Street 1:601 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2701
Practice Address - Country:US
Practice Address - Phone:425-223-2828
Practice Address - Fax:208-262-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4373101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty