Healthcare Provider Details

I. General information

NPI: 1508646860
Provider Name (Legal Business Name): GEM STATE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 W GARVERDALE CT STE 606
BOISE ID
83704-5474
US

IV. Provider business mailing address

10448 W GARVERDALE CT STE 606
BOISE ID
83704-5474
US

V. Phone/Fax

Practice location:
  • Phone: 208-615-9828
  • Fax:
Mailing address:
  • Phone: 208-615-9828
  • 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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SCHUBERT
Title or Position: OWNER
Credential: LPC
Phone: 208-615-9828