Healthcare Provider Details

I. General information

NPI: 1144843285
Provider Name (Legal Business Name): WHOLE HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 05/23/2020
Certification Date: 05/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 W JEFFERSON ST
BOISE ID
83702-4713
US

IV. Provider business mailing address

1422 W CAMEL BACK LN APT 117
BOISE ID
83702-6584
US

V. Phone/Fax

Practice location:
  • Phone: 209-401-2884
  • Fax:
Mailing address:
  • Phone: 209-401-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LEAH RIX
Title or Position: LCSW
Credential: LCSW
Phone: 209-401-2884