Healthcare Provider Details

I. General information

NPI: 1922669373
Provider Name (Legal Business Name): BLUE HUMMINGBIRD COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 W HAYS ST STE 201
BOISE ID
83702-4035
US

IV. Provider business mailing address

1524 W HAYS ST STE 201
BOISE ID
83702-4035
US

V. Phone/Fax

Practice location:
  • Phone: 208-481-8546
  • Fax:
Mailing address:
  • Phone: 208-481-8546
  • 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: MARCY HUMPHREY
Title or Position: OWNER
Credential: LMFT
Phone: 208-481-8546