Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-4085 | ID |
N | 225C00000X | Rehabilitation Counselor | 00108377 | ID |
NPI | 1235463597 |
---|---|
Provider Name | Mrs. Randi Marie Stevens |
First Address | Post Falls, ID 83854-8554 |
Second Address | Coeur D Alene, ID 83814-3381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2009 |
Last Update Date | 29/07/2013 |