Healthcare Provider Details

I. General information

NPI: 1700714334
Provider Name (Legal Business Name): LSS BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 N 2ND ST
COEUR D ALENE ID
83815-3760
US

IV. Provider business mailing address

3270 N 2ND ST
COEUR D ALENE ID
83815-3760
US

V. Phone/Fax

Practice location:
  • Phone: 971-322-7998
  • Fax:
Mailing address:
  • Phone: 971-322-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH R KIRK
Title or Position: OWNDER
Credential: MED
Phone: 971-322-7998