Basic Information
| Provider Information | |||||||||
| NPI: | 1184790677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660448 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Practice Location | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660448 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCPC - 2802 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 26628 | 01 | ID | GROUP HEALTH COOPERATIVE | OTHER | 000010139124 | 01 | ID | REGENCE BLUE SHIELD | OTHER | Q3428 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |