Healthcare Provider Details

I. General information

NPI: 1326819616
Provider Name (Legal Business Name): KIND LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N 6TH ST STE 240
BOISE ID
83702-6092
US

IV. Provider business mailing address

223 N 6TH ST STE 240
BOISE ID
83702-6092
US

V. Phone/Fax

Practice location:
  • Phone: 208-713-0200
  • Fax:
Mailing address:
  • Phone: 208-830-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TINA WILKERSON
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 208-830-8655