Healthcare Provider Details

I. General information

NPI: 1326669482
Provider Name (Legal Business Name): HELENA JUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SANETTA ST
NAMPA ID
83651-5047
US

IV. Provider business mailing address

135 MEFFAN AVE
NAMPA ID
83651-2751
US

V. Phone/Fax

Practice location:
  • Phone: 208-576-6464
  • Fax: 208-392-1378
Mailing address:
  • Phone: 408-661-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number8881010
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: