Healthcare Provider Details

I. General information

NPI: 1033058862
Provider Name (Legal Business Name): WHOLEHEARTED COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 7TH ST
LEWISTON ID
83501-4903
US

IV. Provider business mailing address

3415 7TH ST
LEWISTON ID
83501-4903
US

V. Phone/Fax

Practice location:
  • Phone: 208-717-1650
  • Fax:
Mailing address:
  • Phone: 208-717-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TRACI L BIRDSELL
Title or Position: LMSW
Credential: LMSW
Phone: 208-791-0515