Healthcare Provider Details

I. General information

NPI: 1336734060
Provider Name (Legal Business Name): VIGILANT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 E RIVERPARK LN STE 120
BOISE ID
83706-4000
US

IV. Provider business mailing address

671 E RIVERPARK LN STE 120
BOISE ID
83706-4000
US

V. Phone/Fax

Practice location:
  • Phone: 601-207-2103
  • Fax: 208-379-2181
Mailing address:
  • Phone: 601-207-2103
  • Fax: 208-379-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RYAN VIGILANT
Title or Position: OWNER
Credential: LPC
Phone: 601-207-2103