Avalon Counseling, Llc | |
1250 W Ironwood Dr Ste 303 Coeur D Alene ID 83814-2682 | |
(208) 366-5053 | |
(208) 518-1258 |
Full Name | Avalon Counseling, Llc |
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Speciality | Clinic/Center |
Location | 1250 W Ironwood Dr Ste 303, Coeur D Alene, Idaho |
Authorized Official Name and Position | Lonnie M Stapp (CLINICAL DIRECTOR) |
Authorized Official Contact | 2087715911 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Avalon Counseling, Llc 1250 W Ironwood Dr Ste 303 Coeur D Alene ID 83814-2682 Ph: (208) 771-5911 | Avalon Counseling, Llc 1250 W Ironwood Dr Ste 303 Coeur D Alene ID 83814-2682 Ph: (208) 366-5053 |
NPI Number | 1366099236 |
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Provider Enumeration Date | 08/24/2019 |
Last Update Date | 08/24/2019 |
Medicare PECOS PAC ID | 7810428273 |
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Medicare Enrollment ID | O20241009002469 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366099236 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Lonnie M Stapp |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1538539697 PECOS PAC ID: 3971954975 Enrollment ID: I20240112000763 |
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