Healthcare Provider Details

I. General information

NPI: 1063324028
Provider Name (Legal Business Name): POSITIVE HORIZONS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E 50 S STE 2
MALAD CITY ID
83252-1368
US

IV. Provider business mailing address

148 E 50 S STE 2
MALAD CITY ID
83252-1368
US

V. Phone/Fax

Practice location:
  • Phone: 208-731-0917
  • Fax: 208-851-5141
Mailing address:
  • Phone: 208-851-5141
  • Fax: 208-441-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TYLER COOK
Title or Position: OWNER
Credential: LCSW
Phone: 208-851-5141