Provider Demographics
NPI:1124834262
Name:ANTONE, ALBANA (COU-I)
Entity type:Individual
Prefix:
First Name:ALBANA
Middle Name:
Last Name:ANTONE
Suffix:
Gender:F
Credentials:COU-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:ID
Mailing Address - Zip Code:83555-0089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1995 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:ID
Practice Address - Zip Code:83555-0001
Practice Address - Country:US
Practice Address - Phone:208-792-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2661872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health