Healthcare Provider Details

I. General information

NPI: 1326927146
Provider Name (Legal Business Name): CAROLYN EYRE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W MAIN ST
BOISE ID
83702-7263
US

IV. Provider business mailing address

1311 E CENTRAL DR
MERIDIAN ID
83642-7991
US

V. Phone/Fax

Practice location:
  • Phone: 208-986-4357
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: