Healthcare Provider Details

I. General information

NPI: 1194362517
Provider Name (Legal Business Name): ADVANCED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W PINE AVE
MERIDIAN ID
83642-2281
US

IV. Provider business mailing address

1426 N CAROL ST
MERIDIAN ID
83646-1844
US

V. Phone/Fax

Practice location:
  • Phone: 208-887-6283
  • Fax: 208-297-6038
Mailing address:
  • Phone: 208-887-6283
  • Fax: 208-297-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RODNEY DALE LIMB
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: LCPC, LMFT
Phone: 208-887-6283