Healthcare Provider Details

I. General information

NPI: 1730742016
Provider Name (Legal Business Name): KIMBERLY HINRICHS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S COLE RD
BOISE ID
83709-0934
US

IV. Provider business mailing address

204 S COLE RD
BOISE ID
83709-0934
US

V. Phone/Fax

Practice location:
  • Phone: 208-724-8581
  • Fax: 208-813-6179
Mailing address:
  • Phone: 208-724-8581
  • Fax: 208-813-6179

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: KIMBERLY HINRICHS
Title or Position: OWNER
Credential: LCSW
Phone: 208-724-8581