Sally Anderson Cleary, LPC
Individual provider Active NPI Professional Counselor · Kuna, ID
NPI 1861686321 · NPPES record last updated Aug 28, 2007
Key facts
- NPI
- 1861686321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-3200 (ID)
- Practice address
- 190 W. Main St.
Kuna, ID 83634 - Phone
- (208) 922-9001
- Fax
- (208) 922-3778
- NPI assigned
- Aug 28, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-3200 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Sage Counseling & Wellness PLLC | Professional | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-3200 | ID | Yes |
Addresses
Primary practice location
190 W. Main St.
Kuna, ID 83634
Mailing address
PO Box 959
Kuna, ID 83634-0900
Phone (208) 922-9001
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806162000 | Medicaid | ID |
Other providers in Kuna, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.