Healthcare Provider Details

I. General information

NPI: 1003928961
Provider Name (Legal Business Name): MARINELL RHINE SOLUTIONS FOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 IDAHO ST
AMERICAN FALLS ID
83211-1235
US

IV. Provider business mailing address

239 IDAHO ST
AMERICAN FALLS ID
83211-1235
US

V. Phone/Fax

Practice location:
  • Phone: 208-226-7500
  • Fax: 208-226-7501
Mailing address:
  • Phone: 208-226-7500
  • Fax: 208-226-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-822
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLSW-23983
License Number StateID

VIII. Authorized Official

Name: MRS. MARINELL STEVENSON RHINE
Title or Position: OWNER
Credential: LCSW
Phone: 208-226-7500