Healthcare Provider Details

I. General information

NPI: 1477420685
Provider Name (Legal Business Name): JOSHUA RYCHERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W AMERICANA TER STE 330C
BOISE ID
83706-2547
US

IV. Provider business mailing address

3350 W AMERICANA TER STE 330C
BOISE ID
83706-2547
US

V. Phone/Fax

Practice location:
  • Phone: 208-501-3585
  • Fax:
Mailing address:
  • Phone: 208-501-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7371085
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: