Healthcare Provider Details

I. General information

NPI: 1003258179
Provider Name (Legal Business Name): SUNDERLIN BEHAVIORAL INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 W ROSE HILL ST
BOISE ID
83705-1651
US

IV. Provider business mailing address

3113 W ROSE HILL ST
BOISE ID
83705-1651
US

V. Phone/Fax

Practice location:
  • Phone: 208-297-1405
  • Fax: 805-823-4462
Mailing address:
  • Phone: 208-297-1405
  • Fax: 805-823-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-6753
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. YRENKA LOLLI-SUNDERLIN
Title or Position: EXECUTIVE DIRECTOR
Credential: B.C.B.A.
Phone: 805-208-3875