Healthcare Provider Details

I. General information

NPI: 1427897271
Provider Name (Legal Business Name): COGNITIVE HEALING INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E CENTER ST
POCATELLO ID
83201-6372
US

IV. Provider business mailing address

13345 N MANNING LN
CHUBBUCK ID
83202-5185
US

V. Phone/Fax

Practice location:
  • Phone: 208-244-0795
  • Fax: 208-886-6525
Mailing address:
  • Phone: 208-380-2842
  • Fax: 208-886-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT D LAYTON
Title or Position: OWNER
Credential: LCSW
Phone: 208-380-2842