Healthcare Provider Details

I. General information

NPI: 1598512030
Provider Name (Legal Business Name): VALIANT VITALITY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 N GOVERNMENT WAY STE 10
DALTON GARDENS ID
83815-9200
US

IV. Provider business mailing address

PO BOX 2018
POST FALLS ID
83877-2018
US

V. Phone/Fax

Practice location:
  • Phone: 208-449-5432
  • Fax: 208-601-6142
Mailing address:
  • Phone: 559-907-5116
  • Fax: 208-601-6142

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

VIII. Authorized Official

Name: ESTHER NELSON
Title or Position: OWNER
Credential: LCSW-41400
Phone: 559-907-5116