Healthcare Provider Details

I. General information

NPI: 1598774861
Provider Name (Legal Business Name): QUIET WATERS COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 NYSTROM WAY
BOISE ID
83713-2521
US

IV. Provider business mailing address

4235 NYSTROM WAY
BOISE ID
83713-2521
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-1147
  • Fax:
Mailing address:
  • Phone: 208-378-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC 295
License Number StateID

VIII. Authorized Official

Name: KAREN S. MCCONAUGHEY
Title or Position: COUNSELOR
Credential: LCPC
Phone: 208-378-1147