Healthcare Provider Details

I. General information

NPI: 1972805224
Provider Name (Legal Business Name): EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 16TH ST 110
PAYETTE ID
83661-2781
US

IV. Provider business mailing address

501 N 16TH ST 110
PAYETTE ID
83661-2781
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-2600
  • Fax: 208-642-6164
Mailing address:
  • Phone: 208-642-2600
  • Fax: 208-642-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL STEWART LEE
Title or Position: OWNER
Credential: LCSW
Phone: 208-365-5445