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Chantel Lee Wallace
Mental Health Counselor in Blackfoot, Idaho
NPI 1669234308

Chantel Lee Wallace is a Mental Health Counselor based in Blackfoot, ID and is specialized in Mental Health. Chantel Lee Wallace practices in Blackfoot, ID. The NPI Number for Chantel Lee Wallace is 1669234308 and holds a License No. LMSW-43731 (Idaho).

The current practice location address for Chantel Lee Wallace is 581 N Ash St, Blackfoot, ID and can be reached out via phone at 208-973-5077.

Location: 581 N Ash St, Blackfoot, ID, 83221-2223
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1669234308
Provider Name
Chantel Lee Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
581 N Ash St, Blackfoot, ID, 83221-2223
Phone Number
208-973-5077
Fax Number
Provider Enumeration Date
01/29/2024
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
581 N Ash St
City
Blackfoot
State
Idaho
Zip
83221-2223
Phone Number
208-973-5077
Fax Number
person
Provider Business Mailing Address Details
Address
581 N Ash St
City
Blackfoot
State
Idaho
Zip
83221-2223
Phone Number
208-973-5077
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
LMSW-43731 (Idaho)
Definition
Definition to come...
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