Healthcare Provider Details

I. General information

NPI: 1992007249
Provider Name (Legal Business Name): EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 E QUAIL RUN RD SUITE 1
EMMETT ID
83617-5059
US

IV. Provider business mailing address

2007 E QUAIL RUN RD STE 1
EMMETT ID
83617-5059
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-5445
  • Fax: 208-365-6226
Mailing address:
  • Phone: 208-365-5445
  • Fax: 208-365-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHY WALL
Title or Position: MEMBER/OFFICE MANAGER
Credential:
Phone: 208-365-5445