Healthcare Provider Details

I. General information

NPI: 1417158338
Provider Name (Legal Business Name): COMMUNITY OUTREACH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 GARRITY BLVD STE 5
NAMPA ID
83687-3679
US

IV. Provider business mailing address

2707 GARRITY BLVD STE 5
NAMPA ID
83687-3679
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-7443
  • Fax: 208-466-5058
Mailing address:
  • Phone: 208-466-7443
  • Fax: 208-466-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number26327
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number26327
License Number StateID

VIII. Authorized Official

Name: PAULA S. MARCOTTE
Title or Position: OWNER
Credential: LMSW
Phone: 208-466-7443