Healthcare Provider Details

I. General information

NPI: 1356270219
Provider Name (Legal Business Name): NOVA COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 E GENTRY WAY STE 110
MERIDIAN ID
83642-3060
US

IV. Provider business mailing address

3080 E GENTRY WAY STE 110
MERIDIAN ID
83642-3060
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-1341
  • Fax:
Mailing address:
  • Phone: 208-918-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JASMINE VIEIRA
Title or Position: OWNER
Credential: MS, LPC
Phone: 208-918-1341