Healthcare Provider Details

I. General information

NPI: 1629984265
Provider Name (Legal Business Name): MINI CASSIA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 OVERLAND AVE STE 5A
BURLEY ID
83318-2957
US

IV. Provider business mailing address

PO BOX 492
PAUL ID
83347-0492
US

V. Phone/Fax

Practice location:
  • Phone: 208-260-1883
  • Fax: 208-837-8322
Mailing address:
  • Phone: 208-260-1883
  • Fax: 208-837-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGIE ZABALA
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 208-260-1883