Healthcare Provider Details

I. General information

NPI: 1639089931
Provider Name (Legal Business Name): LILY AND LOOM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

119 E CALDERWOOD DR STE 102
MERIDIAN ID
83642-7482
US

IV. Provider business mailing address

119 E CALDERWOOD DR STE 102
MERIDIAN ID
83642-7482
US

V. Phone/Fax

Practice location:
  • Phone: 208-204-7819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRYNN WRIGHT
Title or Position: THERAPIST/ OWNER
Credential: LCPC
Phone: 208-204-7819