Healthcare Provider Details

I. General information

NPI: 1679497911
Provider Name (Legal Business Name): ANCHOR AND SOUL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GARRETT WAY STE 19
POCATELLO ID
83201-5132
US

IV. Provider business mailing address

5033 HAWTHORNE RD APT 15
CHUBBUCK ID
83202-2261
US

V. Phone/Fax

Practice location:
  • Phone: 208-417-1541
  • Fax:
Mailing address:
  • Phone: 208-269-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS DAVIS
Title or Position: COUNSELOR
Credential: LPC
Phone: 208-269-0601