Masom, Andrea L

Masom, Andrea L is an sole proprietor health care provider with primary practice located at 106 E 3Rd St Suite 2B, Moscow ID 83843-2970. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Masom, Andrea L can be contacted via phone (208) 882-1289.

Contact Information

Primary practice address
106 E 3Rd St Suite 2B Moscow ID 83843-2970
Fax: (208) 882-8406
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X LCPC#3017 Idaho

Profile Details

NPI number 1083623391
LBN Legal business name Masom, Andrea L
Credentials LCPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 5th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083623391 NPPES
Idaho Other Q5977 BLUE CROSS

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