Provider Demographics
NPI:1366099236
Name:AVALON COUNSELING, LLC
Entity type:Organization
Organization Name:AVALON COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-771-5911
Mailing Address - Street 1:1250 W IRONWOOD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:208-771-5911
Mailing Address - Fax:208-518-1258
Practice Address - Street 1:1250 W IRONWOOD DR STE 303
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:208-366-5053
Practice Address - Fax:208-518-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center