Healthcare Provider Details

I. General information

NPI: 1760322390
Provider Name (Legal Business Name): DYNAMIC HORIZONS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 W STATE ST STE 204
BOISE ID
83703-2741
US

IV. Provider business mailing address

6126 W STATE ST STE 204
BOISE ID
83703-2741
US

V. Phone/Fax

Practice location:
  • Phone: 208-806-1900
  • Fax:
Mailing address:
  • Phone: 208-806-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAVID BUCH
Title or Position: OWNER
Credential: LCSW
Phone: 208-407-7519