Healthcare Provider Details

I. General information

NPI: 1952064180
Provider Name (Legal Business Name): FLORA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N MAIN ST STE 210
MERIDIAN ID
83642-1746
US

IV. Provider business mailing address

5254 N CORTONA WAY
MERIDIAN ID
83646-3121
US

V. Phone/Fax

Practice location:
  • Phone: 209-613-9514
  • Fax:
Mailing address:
  • Phone: 209-613-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE JOHNSON
Title or Position: CREDENTIAL SPECIALIST
Credential:
Phone: 727-800-2332