Healthcare Provider Details

I. General information

NPI: 1609643808
Provider Name (Legal Business Name): QUERENCIA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S ORCHARD ST STE 201-1
BOISE ID
83705-3799
US

IV. Provider business mailing address

2200 S ORCHARD ST STE 201-1
BOISE ID
83705-3799
US

V. Phone/Fax

Practice location:
  • Phone: 210-363-1584
  • Fax: 208-900-2082
Mailing address:
  • Phone: 210-363-1584
  • Fax: 208-900-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA PEREZ
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 210-363-1584