Provider Demographics
NPI:1992452841
Name:O'MALLEY, ANNA (MS, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 S PERRAULT WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5594
Mailing Address - Country:US
Mailing Address - Phone:307-251-2014
Mailing Address - Fax:
Practice Address - Street 1:2780 S PERRAULT WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-5594
Practice Address - Country:US
Practice Address - Phone:307-251-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8702101YM0800X
IDLPC8702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health