Healthcare Provider Details

I. General information

NPI: 1780495432
Provider Name (Legal Business Name): SUNNY MARIE ROURKE MS, LPC, LAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 W STATE ST STE A
GARDEN CITY ID
83703-3085
US

IV. Provider business mailing address

1740 E FAIRVIEW AVE # 1001
MERIDIAN ID
83642-5702
US

V. Phone/Fax

Practice location:
  • Phone: 208-477-1302
  • Fax:
Mailing address:
  • Phone: 208-477-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2771081
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23285
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2771081
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: