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Provider Information for 1508396714


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STEVEN RICHARD MINER MS, MFT, LPC


Sex: Male

NPI: 1508396714
Last Updated: 2024-02-16
Certification Date: 2024-02-16

Details

NameValue
NPI1508396714
Enumeration Date2017-06-20
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 500 S 11TH AVE STE 400
POCATELLO, ID 83201-4880
United States

Phone: 208-232-7862 | Fax:208-233-0835
 
Primary Practice Address 1025 W ELDREDGE RD
POCATELLO, ID 83201-5527
United States

Phone: 208-425-2489 | Fax:
 
Secondary Practice Address(es)

1001 N 7TH AVE STE 135
POCATELLO, ID 83201-5790
United States

Phone: 208-425-2489 | Fax:833-908-2327
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthIDLPC-6599