Healthcare Provider Details

I. General information

NPI: 1659280550
Provider Name (Legal Business Name): ANGIE ELIN RECOVERY & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1018 W SANETTA ST
NAMPA ID
83651-5047
US

IV. Provider business mailing address

1018 W SANETTA ST
NAMPA ID
83651-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-0477
  • Fax:
Mailing address:
  • Phone: 208-918-0477
  • 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: ANGIE ELIN MOSES
Title or Position: OWNER
Credential: LMFT
Phone: 801-645-0500