Provider Demographics
NPI:1952568503
Name:DEBAUN, GIGI L (LMFT)
Entity type:Individual
Prefix:
First Name:GIGI
Middle Name:L
Last Name:DEBAUN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N ORCHARD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2035
Mailing Address - Country:US
Mailing Address - Phone:208-429-0330
Mailing Address - Fax:208-429-0330
Practice Address - Street 1:716 N ORCHARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2035
Practice Address - Country:US
Practice Address - Phone:208-429-0330
Practice Address - Fax:208-429-0330
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-2725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist