| Cynthia Louise Lange, Llc | |
|
330 S 4th Ave Pocatello ID 83201-6403 | |
| (406) 848-4827 | |
| Not Available |
| Full Name | Cynthia Louise Lange, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 330 S 4th Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Deborah A Goss (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2082211161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cynthia Louise Lange, Llc 330 S 4th Ave Pocatello ID 83201-6403 Ph: (406) 848-4827 | Cynthia Louise Lange, Llc 330 S 4th Ave Pocatello ID 83201-6403 Ph: (406) 848-4827 |
| NPI Number | 1174170708 |
|---|---|
| Provider Enumeration Date | 08/19/2019 |
| Last Update Date | 08/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174170708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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