Provider Demographics
NPI:1487478657
Name:WOLF, EMILY R (LMFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13684 N SAGE GROUSE PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3000
Mailing Address - Country:US
Mailing Address - Phone:310-266-2813
Mailing Address - Fax:
Practice Address - Street 1:1065 E WINDING CREEK DR STE 250
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7246
Practice Address - Country:US
Practice Address - Phone:310-266-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-10019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist