Healthcare Provider Details

I. General information

NPI: 1740193440
Provider Name (Legal Business Name): CATCH & RELEASE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 E DAKOTA AVE
HAYDEN ID
83835-8272
US

IV. Provider business mailing address

685 E DAKOTA AVE
HAYDEN ID
83835-8272
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-6788
  • Fax:
Mailing address:
  • Phone: 208-659-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN ETTNER
Title or Position: MENTAL HEALTH CLINICIAN
Credential: LCSW LICSW ACM
Phone: 208-659-6788