Healthcare Provider Details

I. General information

NPI: 1174459051
Provider Name (Legal Business Name): GABRIELLE NICOLE NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CLEVELAND BLVD APT A
CALDWELL ID
83605-5031
US

IV. Provider business mailing address

1701 CLEVELAND BLVD APT A
CALDWELL ID
83605-5031
US

V. Phone/Fax

Practice location:
  • Phone: 208-724-3649
  • Fax:
Mailing address:
  • Phone: 208-724-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2781810
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: