Healthcare Provider Details

I. General information

NPI: 1376089896
Provider Name (Legal Business Name): PINNACLE COUNSELING CENTER NORTHWEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N LAKEWOOD DR STE 220
COEUR D ALENE ID
83814-2473
US

IV. Provider business mailing address

PO BOX 3415
HAYDEN ID
83835-3415
US

V. Phone/Fax

Practice location:
  • Phone: 208-699-9065
  • Fax:
Mailing address:
  • Phone: 208-699-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-36216
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW-36216
License Number StateID

VIII. Authorized Official

Name: KIMBERLY S LEE
Title or Position: OWNER
Credential: LCSW
Phone: 208-699-9065