Provider Demographics
NPI:1346790128
Name:TORRES, MOLLI SUE
Entity type:Individual
Prefix:MRS
First Name:MOLLI
Middle Name:SUE
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MOLLI
Other - Middle Name:SUE
Other - Last Name:GILCHRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:760 K ST APT 12
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2762
Mailing Address - Country:US
Mailing Address - Phone:208-715-0539
Mailing Address - Fax:
Practice Address - Street 1:415 PARISH CT
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-3169
Practice Address - Country:US
Practice Address - Phone:253-921-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health