Healthcare Provider Details

I. General information

NPI: 1215892690
Provider Name (Legal Business Name): A TIME FOR CHANGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 W 18TH ST
BURLEY ID
83318-2206
US

IV. Provider business mailing address

737 W 18TH ST
BURLEY ID
83318-2206
US

V. Phone/Fax

Practice location:
  • Phone: 208-568-5348
  • Fax:
Mailing address:
  • Phone: 208-568-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TABATHA J BAUMGARTNER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 208-219-9196