Healthcare Provider Details

I. General information

NPI: 1013494301
Provider Name (Legal Business Name): LABYRINTH ASSESSMENT & BEHAVIORAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N MAIN ST STE 6
MALAD CITY ID
83252-1281
US

IV. Provider business mailing address

20 N MAIN ST STE 6
MALAD CITY ID
83252-1281
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-9136
  • Fax: 208-233-9136
Mailing address:
  • Phone: 208-766-7623
  • Fax: 183-382-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCPC3275
License Number StateID

VIII. Authorized Official

Name: DONNA CALL
Title or Position: CREDENTIALING
Credential:
Phone: 208-317-0268