Healthcare Provider Details

I. General information

NPI: 1538997499
Provider Name (Legal Business Name): ILEANA ISABELLE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 N HARBOR LN STE 100
BOISE ID
83703-6919
US

IV. Provider business mailing address

846 N ASH PINE WAY
MERIDIAN ID
83642-1213
US

V. Phone/Fax

Practice location:
  • Phone: 208-985-2527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1861363
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: