Healthcare Provider Details

I. General information

NPI: 1184336307
Provider Name (Legal Business Name): HEART ALCHEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E WARM SPRINGS AVE STE D2
BOISE ID
83712-6475
US

IV. Provider business mailing address

4092 S MILL SITE AVE
BOISE ID
83716-8637
US

V. Phone/Fax

Practice location:
  • Phone: 208-402-8166
  • Fax:
Mailing address:
  • Phone: 208-991-7782
  • 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: JULI EILEEN JOHNSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 208-402-8166