Provider Information for 1780016261
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LORA R HASSE LCPC
Sex: Female
NPI: 1780016261
Last Updated: 2020-05-01
Certification Date: 2020-05-01
Certification Date: 2020-05-01
Details
| Name | Value | ||||||||
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| NPI | 1780016261 | ||||||||
| Enumeration Date | 2013-08-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 12575 W GAMBRELL ST STAR, ID 83669-5024 United States Phone: 208-287-5613 | Fax: | ||||||||
| Primary Practice Address | 400 N BENJAMIN LN 201 BOISE, ID 83704-5094 United States Phone: 208-287-5613 | Fax: | ||||||||
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