Healthcare Provider Details

I. General information

NPI: 1255242319
Provider Name (Legal Business Name): CROI CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S. 14TH ST
BOISE ID
83702
US

IV. Provider business mailing address

509 S. 14TH ST
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-570-2791
  • Fax:
Mailing address:
  • Phone: 208-570-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARNAE WALKER
Title or Position: LICENSED CLINICAL PROF. COUNSELOR
Credential: LCPC
Phone: 208-570-2791