Healthcare Provider Details

I. General information

NPI: 1255977914
Provider Name (Legal Business Name): CENTER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 EVANS LN
CHUBBUCK ID
83202-1914
US

IV. Provider business mailing address

265 E CHUBBUCK RD
CHUBBUCK ID
83202-5055
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-3907
  • Fax: 208-242-3786
Mailing address:
  • Phone: 208-237-1711
  • Fax: 208-237-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ARLENE GOSS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 208-221-1161