Healthcare Provider Details

I. General information

NPI: 1568393593
Provider Name (Legal Business Name): LILLIAN ARCHULETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILY ARCHULETA

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W JEFFERSON ST
BOISE ID
83702-5110
US

IV. Provider business mailing address

228 S CEDAR POINTE AVE
NAMPA ID
83686-5583
US

V. Phone/Fax

Practice location:
  • Phone: 208-817-0234
  • Fax:
Mailing address:
  • Phone: 208-484-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8381115
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: