Healthcare Provider Details

I. General information

NPI: 1104374974
Provider Name (Legal Business Name): CENTER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 EAST CHUBBUCK
CHUBBUCK ID
83202-5055
US

IV. Provider business mailing address

265 EAST CHUBBUCK
CHUBBUCK ID
83202-5055
US

V. Phone/Fax

Practice location:
  • Phone: 208-406-3399
  • Fax:
Mailing address:
  • Phone: 208-237-1711
  • Fax: 208-237-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MCKEE
Title or Position: OWNER
Credential:
Phone: 208-237-1711