Healthcare Provider Details

I. General information

NPI: 1972463768
Provider Name (Legal Business Name): QUALLS FOOTNOTES COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E WARM SPRINGS AVE STE F
BOISE ID
83712-6457
US

IV. Provider business mailing address

750 E WARM SPRINGS AVE STE F
BOISE ID
83712-6457
US

V. Phone/Fax

Practice location:
  • Phone: 208-254-1027
  • Fax:
Mailing address:
  • Phone: 208-254-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH LYNN KETURAH COTNER
Title or Position: OWNER/LCSW
Credential: LCSW
Phone: 208-254-1027