Lisa Michelle Koller, SUDA
NPI #1467221093 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1467221093
- Entity Type
- Individual
- Name
- Lisa Michelle Koller, SUDA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Credential
- SUDA
- Enumeration Date
- Dec 22, 2023
- Last Updated
- Dec 22, 2023
Practice Location
- Address
- 1810 W BROADWAY ST
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83402-5072
- Phone
- (208) 313-4550
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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