Healthcare Provider Details

I. General information

NPI: 1811871940
Provider Name (Legal Business Name): MINDFUL RECOVERY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E POPLAR AVE
COEUR D ALENE ID
83814-3435
US

IV. Provider business mailing address

129 E POPLAR AVE
COEUR D ALENE ID
83814-3435
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-6122
  • Fax: 866-606-2375
Mailing address:
  • Phone: 208-819-6122
  • Fax: 866-606-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH CHRISTINA CARDER
Title or Position: OWNER
Credential: LCSW, AADC
Phone: 208-819-6122