Healthcare Provider Details

I. General information

NPI: 1689286643
Provider Name (Legal Business Name): CHOOSE YOUR PATH COUNSELING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 E MAIN ST STE 4
GRANGEVILLE ID
83530-2283
US

IV. Provider business mailing address

1585 BATTLE RIDGE RD
KOOSKIA ID
83539-5092
US

V. Phone/Fax

Practice location:
  • Phone: 208-553-8137
  • Fax: 208-298-3851
Mailing address:
  • Phone: 208-553-8137
  • Fax: 208-298-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MARIE BUTTS
Title or Position: OWNER/LCSW
Credential:
Phone: 208-553-8137