Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7702 | ID |
NPI | 1003434887 |
---|---|
Provider Name | Mrs. Mary Claire Fery |
First Address | Boise, ID 83703-3851 |
Second Address | Nampa, ID 83651-3963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 08/07/2020 |